40 3 Eyelid Neoplasms


● These can present from very small to large. ● They may be crusted with bleeding or smooth ( Fig. 3-5 ). Differential Diagnosis ● Actinic keratosis ● Basal cell carcinoma ● Keratoacanthoma Laboratory Tests ● Pathologic evaluation Treatment ● Complete surgical excision with controlled margins ● Frozen sections and Mohs surgery are both appropriate options. ● Imiquimod cream can be used as a nonsur gical option if not close to the eyelid margin. Prognosis ● Excellent unless the lesion is neglected ● Squamous cell carcinoma rarely spreads via lymphatics, blood vessels, or along nerves.

S quamous cell carcinoma is a malignant tu mor of epithelial keratinocytes. It is often the result of exogenous carcinogens (ultravi olet exposure, exposure to ionizing radiation, arsenic). These lesions are much less common than basal cell carcinoma on the eyelids and are usually successfully treated with excision. Epidemiology and Etiology ● Age: Older than 55 years ● Gender: Males more commonly involved than females ● Etiology: Sun exposure and fair skin with poor ability to tan are risk factors. Treatment with x-ray (for acne) increases the risk. ● Incidence: 12 per 100,000 white males; 7 per 100,000 white females; 1 per 100,000 African Americans History ● Persistent keratotic lesion or plaque that does not resolve after 1 month must be con sidered a potential carcinoma, especially in sun-exposed areas. Examination ● Two types of lesions: ■ Differentiated lesions are keratinized, firm, and hard. ■ Undifferentiated lesions are fleshy, gran ulomatous, and soft.

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