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.
For more information, visit our website at www.facialworks.com.
For more information, visit our website at www.facialworks.com.