Eyelid Tumors, Second Edition


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Sebaceous gland carcinoma is more common in the upper eyelid but can also occur in the lower eyelid.

It usually presents as a solitary yellow nodule resembling a chalazion. The pagetoid variety of SGC may resemble blepharoconjunctivitis in its clinical presentation. Like other malignant eyelid tumors, SGC may be associated with loss of lashes. SGC can invade and replace eyelid skin and conjunctival epithelium in a pagetoid fashion. The infiltrated epithelium is thickened and sometimes totally replaced by the tumor cells. Delayed or mistaken diagnosis is very common and thus locally advanced cases are not uncommon.

Patients with SGC of the eyelid should be screened for Muir-Torre syndrome, [ 28 ] a rare autosomal dominant syndrome consisting of sebaceous gland tumors hyperplasia, adenoma or carcinoma and internal malignancies colon cancer and other malignancies. A baseline colonoscopy, a gynecologic examination in women and other baseline imaging studies, to rule out other associated malignancies, are indicated at the time of initial diagnosis of SGC. Sebaceous gland carcinoma is composed of lobules or sheets of large, pleomorphic tumor cells with a foamy cytoplasm due to lipid vacuoles.

The lipid can be demonstrated using special lipid stains such as Oil-red-O on fresh tissue that has not been formalin fixed. SGC also expresses Cam 5. The management of SGC consists of complete surgical excision with control of margins.

Map biopsies of the eyelids and conjunctiva are obtained to rule out pagetoid involvement. In the case of diffuse pagetoid intraepithelial neoplasia of the conjunctiva or eyelids and in the case of postseptal orbital invasion, orbital exenteration may be indicated as the best way to achieve local control.

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External-beam radiation therapy should be reserved for cases of recurrent or locally advanced disease, in which complete surgical excision cannot be accomplished and for patients who are poor candidates for extensive surgery. Topical chemotherapy with mitomycin C MMC has also been used successfully for the treatment of intraepithelial neoplasia. SGC can metastasize to distant organs such as the lung, liver, brain and skull. Periocular melanoma usually occurs in the malar region over an area of lentigo melanoma. Cutaneous melanoma is composed of neoplastic melanocytes. Several studies have demonstrated that as with cutaneous melanomas in other locations, tumor thickness is an important predictor of regional lymph node metastasis and survival in patients with eyelid melanoma.

The major prognostic parameter is the depth of invasion as measured from the top of the granular layer of the epidermis to the point of deepest invasion into the dermis. Management of eyelid and periocular melanoma is similar to management of other cutaneous melanomas. Wide surgical excision is the treatment of choice for local control. Control of surgical margins should be done but there is controversy about which technique is better.

Frozen sections are controversial because they can induce some difficulties in the diagnosis.

Mohs surgery via serial mapped excision may also be useful. In the head and neck in general, and in the periocular region in particular, the WHO recommendation of at least 1 cm margins for melanomas less than or equal to 1 mm is not always possible if the goal is preservation of the globe and its function. A patient with a newly diagnosed eyelid melanoma should undergo ultrasonography of the regional lymph nodes to rule out clinically positive lymph nodes. The role of sentinel lymph node biopsy for more accurate staging of the regional lymph nodes has evolved in the last decade.

Merkel cell carcinoma is a malignant tumor that arises from Merkel cells mechanoreceptors for touch. The tumor generally occurs in older patients. Clinically, Merkel cell carcinoma usually presents as a reddish-blue lesion. Wide surgical excision followed by external-beam radiation therapy to the primary site is probably the best treatment although there is not enough information to assume that one particular approach is better than the other.

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Metastatic eyelid tumors can originate from a variety of primary cancers including breast, lung and kidney, or from cutaneous melanoma. Metastatic eyelid tumors are characterized by a rapidly growing eyelid nodule that may be mistaken for an inflammatory lesion. No writing assistance was utilized in the production of this manuscipt. Author's email: eyemd ada. Author's email: besmaeli mdanderson. Disclosure: The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript.

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Eyelid, Conjunctival, and Orbital Tumors: An Atlas and Textbook

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Intraocular melanoma is the most common type of cancer that develops within the eyeball in adults, but it is still fairly rare. Melanomas that start in the skin are much more common than melanomas that start in the eye. Melanomas develop from pigment-making cells called melanocytes. When melanoma develops in the eye, it is usually in the uvea uveal melanomas and rarely in the conjunctiva conjunctival melanomas. About 9 out of 10 intraocular melanomas develop in the choroid or ciliary body.


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Most of the other intraocular melanomas start in the iris. These are the easiest for a person or their doctor to see because they often start in a dark spot on the iris that has been present for many years and then begins to grow.

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