Monday, February 11, 2013

Skin Cancer of the Eyelid

Distinguishing a potentially malignant eyelid lesion can be particularly difficult, considering the eyelid's propensity for developing both benign and cancerous lesions.  However, like in other areas of the body, the thin, sun exposed areas of the eyelid can exhibit warnings signs that should indicate a potential problem. 

The “ABCD” method is a helpful tool to help spot suspicious growths:

A is for Asymmetry: A lesion that is asymmetrical in shape or that appears to grow randomly in direction is a warning sign of a potentially cancerous growth.   

B is for irregular Border: A lesion that has an irregular or “rough” border as opposed to a clean edge on its circumference increases our suspicion for malignancy.

C is for Color inconsistency and shade: A lesion that displays various shades or colors, as opposed to a single uniform color or shade, is also more suspicious for malignancy. 

D is for Diameter: A growth that is increasing in size and becoming larger should be evaluated by a physician, with a lesion being larger than 6mm being very suspicious for a possible abnormal growth.

Any lesion that changes in size, becomes ulcerated or bleeds, or which previously went away or was removed and recurs should warrant suspicion and prompt further investigation by a trained physician.  For lesions growing on the eyelid margins, loss of lashes is huge “red flag” for malignancy.

The most common skin cancer on the eyelid is basal cell carcinoma, accounting for approximately 90% of all cutaneous malignancies.  Classic indicators of disease include a lesion with raised, pearly borders, often featuring teleangectasias (small blood vessels near the surface of the skin).

Squamous cell and sebaceous cell carcinomas are less frequent but potentially more dangerous cancers, with higher rates of metastasis.  These lesions may be scaly or ulcerated.  They may mimic more benign conditions of the eye, such as blepharitis or a recurrent chalazion.  Lid eversion can be a particularly valuable maneuver in these examinations.

The most important fact to remember is that no clinical sign can definitively indicate whether or not a lesion is benign or malignant.  A biopsy with examination by a pathologist is the only way to confirm diagnosis, and should be performed whenever suspicion arises.

The use of frozen section analysis or a Mohs micrographic surgery is also an important consideration, as is the extent and type of lid reconstruction that may be indicated, and proper referral can be of the utmost importance to successful patient management and morbidity.

Management of eyelid skin lesions can be facilitated by keeping a watch for both the warnings signs of malignancy and the features of the individual skin cancers.  Patient well-being and satisfaction can be achieved by employing biopsy whenever indicated, and implementing proper lid reconstruction when necessary.  In most cases skin cancers can be managed, and even eliminated, with successful cosmetic appearance maintained, when the appropriated actions are taken.

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