Management of Eyelid Tumors

in Daily Practice
CHRISTINA INDRAJATI

Department of Ophthalmology
Faculty of Medicine Sultan Agung University
 Diagnosis of Eyelid Tumors
• Eyelid tumors:
– Benign

– Malignant
 The Eyelid
The eyelids  one of the most observed part of
the eye

Eyelid tumors can be diagnosed at an early

stage
 Features of Benign Lesions

• Slow growth over months to years

• Well demarcated borders

• Intact epithelium
Features of Malignant Lesions
• Slow growth to rapid growth over weeks to
months

• Infiltrative, ill-defined borders

• Epithelium may be ulcerated

BENIGN EYELID TUMORS
 Benign Eyelid Tumors
Several examples of benign eyelid tumor:
• Papilloma
• Nevus
• Seborrheic keratosis
• Xanthelasma
• Capillary Hemangioma
• Epidermal Inclusion Cyst
• Verucca vulgaris
 Papilloma
• Flesh-coloured

• Pedunculated lesion

Therapy: Excision
 Nevus
• Deeply pigmented to amelanotic

Therapy:
• Excision
• Excision + Reconstruction
 Seborrheic Keratosis

• Lobulated

• Papillary

• Pedunculated

Therapy:

Excision + Histopathology
 Xanthelasma
• Multiple yellowish

• Slightly elevated papules

• Plaque usually located at the medial

aspect of the eyelid

Therapy: Excision
 Capillary Hemangioma
• Bright red to deep purple lobulated

• Soft eyelid mass

• Unilateral

Therapy:
• Corticosteroid injection
• Oral Propanolol
 Epidermal Inclusion Cyst

• Yellowish color

• Smooth dome-shape nodul of varying size

Therapy: Excision
Eyelid Inflamation
MALIGNANT EYELID
TUMORS
 Malignant Eyelid Tumors

• Basal Cell Carcinoma

• Squamous Cell Carcinoma

• Sebaceous Cell Carcinoma

• Malignant Melanoma
 Signs and Symptoms

• Eyelid mass
• Pain
• Discharge
• Bleeding
• Madarosis
 Management

 Main Goals:

Tumor Eradication

Visual Preservation

Eyelid Function and Cosmetics

Depends on location, size and tumor’s pathologic
behaviour.
 Basal Cell Carcinoma
Clinical Features
 Locally destructive
 Slow growing,
no metastatic potential
 Lower eyelid (50-60%)
 Medial canthus (25-30%)

Elshamma NA, Al Qabbani A, Alkatan HM, Al-Qattan MM. The use of forehead flaps in the management of large
basal cell carcinomas of the medial canthus/medial lower eyelid in Saudi patients. Saudi J Ophthalmol. 2013
Jul;27(3):223–5.
.
 Upper eyelid (15%)

 Lateral canthus (5%)

Pandey S, Sharma V, Titiyal G, Satyawali V. Sequential occurrence of basal cell carcinoma in symmetrically identical
positions of both lower eyelids: A rare finding of a common skin cancer. Oman J Ophthalmol. 2010;3(3):145
• Nodular or noduloulcerative type

• Madarosis

Pandey S, Sharma V, Titiyal G, Satyawali V. Sequential occurrence of basal cell carcinoma in symmetrically identical positions of both lower eyelids: A rare
finding of a common skin cancer. Oman J Ophthalmol. 2010;3(3):145.
 Basal Cell Carcinoma
Therapy:

• Wide excision with frozen section +

Reconstruction

• Orbital invasion: Exenteration

Risk Factors:
 Extrinsic: elderdy, male, smoking, HPV
infection, ultraviolet exposure
 Intrinsic: albinism, xeroderma
pigmentosum

Characteristics:
Locally invasive
Can invade to orbital and paranasal sinus
Metastazise
 Squamous Cell Carcinoma
Clinical Features
• Whitish mass, erythema, crusted, keratotic lesion,
• Ulcerates centrally, irritating and bleeding

Arora RS, Bhattacharya A, Adwani D, Arora SS. Massive Periocular Squamous Cell Carcinoma Engulfing the Globe: A Rare Case Report. Case Rep Oncol
Med. 2014;2014:1–4.
 Squamous Cell Carcinoma
Clinical Features

• More advanced  highly aggresive & invade the orbit

.
.
 Squamous Cell Carcinoma
Therapy:

• Wide excision followed by reconstruction

of the eyelid
• Exenteration
 Sebaceous Cell Carcinoma
Clinical Features
• Often mimic blepharoconjunctivitis or chronic and
multiple chalazion in the same place
• Hard yellowish nodule at tarsus or margo
• Immobile
• Lymph node enlargement
• Could metastazise

Sung D, Kaltreider SA, Gonzalez-Fernandez F. Early onset sebaceous carcinoma. Diagn Pathol. 2011;6:81.
• Solitary eyelid nodule and diffuse eyelid
thickening

.
• Occurs more often on the upper eyelid
 Sebaceous Cell Carcinoma
• Therapy:
a. Wide Excision with frozen section +
Reconstruction
b. Orbital invasion exenteration
• Prognosis:
 Poor prognosis  diameter >10 mm,
metastized (+)
 Orbital invasion
 Possibility of recurrence
 Malignant Melanoma
Clinical Features
• Pigmented mass
• Mostly occured on the lower eyelid
• Relatively rare < 1% of the malignant
lesions of the eyelid

Harish V, Bond JS, Scolyer RA, Haydu LE, Saw RPM, Quinn MJ, et al. Margins of excision and prognostic factors for cutaneous eyelid
melanomas. J Plast Reconstr Aesthet Surg. 2013 Aug;66(8):1066–73.
 Malignant Melanoma
Therapy:

• Wide excision

• Exenteration
 Summary

Diagnosis of Eyelid Tumors:

• Clinical features

• Biopsy and histopathogical examination

• Imaging technique
Accurate diagnosis
Summary

Treatment of eyelid tumor:

• Small  excisional biopsy

• Large  incisional biopsy

Definitive operation  based on the

diagnosis
 Points to be Concerned of
• Most malignant eyelid tumors:
– Could mimic benign lesions

– Could easily misdiagnosis

• Histopathological examination is recommended

in every case
• Eviserasio bulbi :
• Mengeluarkan seluruh isi bola mata dan membuang
dinding bola mata bagian depan

• Enukleasi bulbi:
• Mengambil seluruh bola mata

• Eksenterasio orbita :
• Mengambil seluruh isi rongga orbita sampai ke perios
orbita
2. Retinoblastoma
• Kongenital, plg sering pada anak-anak
• Dimulai dari retina posterior
• Umur :< 4 tahun ( 70% kasus )
• Bilateral : 25-30% kasus tapi tidak selalu bersamaan
• Perjalanan penyakit :
• Esotropia
• Reflek kuning
• Reflek putih( leukokoria )
• Glaukoma sekunder
• Ekstra okuler ( sdh menyebar kemana-mana )
• Metastase
• Degenerasi→kalsifikasi
• Regresi spontan hanya pada sebagian kecil
• Diagnosis banding :
• Katarak kongenital ( pupil yg berwrn putih )
• Endoftalmitis
• Fibroplasia retrolental
• Hyperplastik vitreous primer persisten
• Koloboma koroid
• Penyakit Coat
• Diagnosa :
• Riwayat keluarga
• Gejala/tanda klinik
• X-Ray : tampak kalsifikasi
• Diagnosis pasti : PA
• Kematian :Metastase ( kranial 50%,umum 40%
• mulut,10%)
• Terapi :
• Fotokoagulasi/laser saat tumor masih kecil
• Bedah ( enukleasi, eksenterasi )
• Radioterapi
• Kemoterapi