1. MALIGNANT EYELID TUMOURS
1. Basal cell carcinoma
2. Squamous cell carcinoma
3. Meibomian gland carcinoma
4. Melanoma
5. Kaposi sarcoma
6. Merkel cell carcinoma
7. Treatment

2. Basal Cell Carcinoma - Important Facts
1. Most common human malignancy
2. Usually affects the elderly
3. Slow-growing, locally invasive
4. Does not metastasize
5. 90% occur on head and neck
6. Of these 10% involve eyelids
7. Accounts for 90% of eyelid malignancies

3. Frequency of location of basal cell carcinoma
Lower lid - 70%
Medial canthus - 15%
Upper lid - 10%
Lateral canthus - 5%

4. Nodular basal cell carcinoma
Early
Advanced
Slow progression
Shiny, indurated nodule
Surface vascularization
May destroy large portion of eyelid

5. Ulcerative basal cell carcinoma
(rodent ulcer)
Early
Advanced
Chronic ulceration
Raised rolled edges and bleeding

6. Sclerosing basal cell carcinoma
Early
Advanced
Spreads radially beneath normal
epidermis
Indurated plaque with loss of lashes
May mimic chronic blepharitis
Margins impossible to delineate

7. Histology of basal cell carcinoma
Cell nests in fibrous stroma
Downgrowth from epidermis
of small, dark atypical basal cells
Peripheral palisading

8. Squamous cell carcinoma
Less common but more aggressive than BCC
May arise de novo or from actinic keratosis
Predilection for lower lid
Nodular
Ulcerative
Hard, hyperkeratotic nodule
Red base
May develop crusting fissures
Borders sharply defined, indurated
and elevated
No surface vascularization

9. Histology of squamous cell carcinoma
Prominent nuclei and
abundant acidophilic
cytoplasm
Variable sized groups of atypical
epithelial cells within dermis
Keratin ‘pearl’

10. Meibomian gland carcinoma
Very rare aggressive tumour with 10% mortality
Predilection for upper lid
Nodular
Hard nodule; may
mimic a chalazion
Very large tumour
Spreading
Diffuse thickening of lid
margin and loss of lashes
Conjunctival invasion; may
mimic chronic conjunctivitis

11. Histology of meibomian gland carcinoma
Cells contain foamy vacuolated
cytoplasm and large
hyperchromatic nuclei
Cells stain positive for fat

12. Melanoma Nodular Superficial spreading From lentigo maligna
(Hutchinson freckle)
Plaque with irregular
outline
Blue-black nodule with
normal surrounding skin
Affects elderly
Slowly expanding
pigmented macule
May be non-pigmented
Variable pigmentation

13. Kaposi sarcoma Vascular tumour occurring in patients with AIDS
Usually associated with advanced disease
Very sensitive to radiotherapy
Early
Advanced
Pink, red-violet lesion
May ulcerate and bleed

14. Merkel cell carcinoma
Highly malignant with frequent metastases at presentation
Fast-growing, violaceous, well-demarcated nodule
Intact overlying skin
Predilection for upper eyelid

15. Treatment Options 1. Surgical excision 2. Radiotherapy 3. Cryotherapy
Method of choice
2. Radiotherapy
Small BCC not involving medial
canthus
Kaposi sarcoma
3. Cryotherapy
Small and superficial BCC
irrespective of location
Adjunct to surgery in selected cases

16. Lower eyelid reconstruction following tumour excisiona b
Direct closure of small defect a b b
Tenzel flap for
moderate defect
Mustarde cheek rotation
flap for large defect

17. Eyelid-sharing procedure
Extensive sclerosing BCC
Total excision of lower lid
Tarsoconjunctival flap
Appearance after healing
Reconstruction of
posterior lamella
Reconstruction of anterior
lamella with skin graft