Subscribe to RSS
DOI: 10.1055/a-1996-0950
Clinical Signs for Differential Diagnosis of Eyelid Tumours
Klinische Zeichen zur Differenzialdiagnose von Augenlidtumoren![](https://www.thieme-connect.de/media/klimo/202301/lookinside/thumbnails/10-1055-a-1996-0950_kl2724-1.jpg)
Abstract
This article aims to present the differential diagnostics of benign and malignant eyelid tumours. The most common malignant eyelid tumour is basal cell carcinoma, followed by squamous cell carcinoma. The common signs of malignity are loss of lashes, ulceration, and infiltration of the lesion. Often the clinical appearance is various and therefore only a histological analysis gives the proper diagnosis. For most tumours, surgical resection is the gold standard of therapy. The reconstruction of the defects should be performed by an experienced oculoplastic surgeon. In malignant tumours that require large safety margins, the defect can be easily very large, and the reconstruction must then be performed with advanced ophthalmic plastic reconstruction techniques.
Zusammenfassung
Dieser Artikel zielt darauf ab, die Differenzialdiagnostik von gutartigen und bösartigen Augenlidtumoren darzustellen. Der am häufigsten bösartige Augenlidtumor ist das Basalzellkarzinom, gefolgt vom Plattenepithelkarzinom. Die häufigsten Anzeichen von Malignität sind Verlust von Wimpern, Ulzeration und Infiltration der Läsion. Das klinische Erscheinungsbild ist vielfältig und daher nur ein histologisches. Die Analyse liefert die richtige Diagnose. Bei den meisten Tumoren ist die chirurgische Resektion der Goldstandard der Therapie. Die Rekonstruktion sollte von einem erfahrenen ophthalmoplastischen Chirurgen durchgeführt werden. Bei bösartigen Tumoren, die großen Sicherheitsabstand erfordern, kann der Defekt leicht sehr groß werden. Die Rekonstruktion muss dann mit fortgeschrittenen Techniken der plastischen Rekonstruktion durchgeführt werden.
Schlüsselwörter
Augenlider - okuläre Onkologie - Augenlidtumor - Basaliom - okuloplastische ChirurgiePublication History
Received: 25 August 2022
Accepted: 05 December 2022
Article published online:
27 January 2023
© 2023. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Peʼer J. Pathology of eyelid tumors. Indian J Ophthalmol 2016; 64: 177-190 DOI: 10.4103/0301-4738.181752.
- 2 Copcu E, Sivrioglu N, Culhaci N. Cutaneous horns: are these lesions as innocent as they seem to be?. World J Surg Oncol 2004; 2: 18 DOI: 10.1186/1477-7819-2-18.
- 3 Shih CC, Yu HS, Tung YC. et al. Inverted follicular keratosis. Kaohsiung J Med Sci 2001; 17: 50-54
- 4 Kwiek B, Schwartz RA. Keratoacanthoma (KA): An update and review. J Am Acad Dermatol 2016; 74: 1220-1233 DOI: 10.1016/j.jaad.2015.11.033.
- 5 Gleich T, Chiticariu E, Huber M. et al. Keratoacanthoma: a distinct entity?. Exp Dermatol 2016; 25: 85-91 DOI: 10.1111/exd.12880.
- 6 Leibovitch I, Huilgol SC, James CL. et al. Periocular keratoacanthoma: can we always rely on the clinical diagnosis?. Br J Ophthalmol 2005; 89: 1201-1204 DOI: 10.1136/bjo.2005.072470.
- 7 Grossniklaus HE, Wojno TH, Yanoff M. et al. Invasive keratoacanthoma of the eyelid and ocular adnexa. Ophthalmology 1996; 103: 937-941 DOI: 10.1016/s0161-6420(96)30583-6.
- 8 Becher OJ, Souweidane M, Lavi E. et al. Large congenital melanotic nevi in an extremity with neurocutaneous melanocytosis. Pediatr Dermatol 2009; 26: 79-82 DOI: 10.1111/j.1525-1470.2008.00828.x.
- 9 Dellon AL, Edelson RL, Chretien PB. Defining the malignant potential of the giant pigmented nevus. Plast Reconstr Surg 1976; 57: 611-618 DOI: 10.1097/00006534-197605000-00008.
- 10 McDonnell PJ, Mayou BJ. Congenital divided naevus of the eyelids. Br J Ophthalmol 1988; 72: 198-201 DOI: 10.1136/bjo.72.3.198.
- 11 Gaca PJ, Doulis A, Wawer Matos PA. et al. [Divided tumor of the upper and lower eyelids]. Ophthalmologe 2022; 119: 410-413 DOI: 10.1007/s00347-021-01489-z.
- 12 Agarwal P, Patel BC. Nevus of Ota and Ito. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. Accessed December 12, 2022 at: https://www.ncbi.nlm.nih.gov/books/NBK560574/
- 13 Shields CL, Kaliki S, Livesey M. et al. Association of ocular and oculodermal melanocytosis with the rate of uveal melanoma metastasis: analysis of 7872 consecutive eyes. JAMA Ophthalmol 2013; 131: 993-1003 DOI: 10.1001/jamaophthalmol.2013.129.
- 14 Patel BC, Egan CA, Lucius RW. et al. Cutaneous malignant melanoma and oculodermal melanocytosis (nevus of Ota): report of a case and review of the literature. J Am Acad Dermatol 1998; 38: 862-865 DOI: 10.1016/s0190-9622(98)70477-3.
- 15 Das D, Deka P, Ramachandra V. et al. Profile of ocular and adnexal tumours at a tertiary institute of northeast India. Orbit 2014; 33: 412-415 DOI: 10.3109/01676830.2014.949789.
- 16 Singh AD, McCloskey L, Parsons MA. et al. Eccrine hidrocystoma of the eyelid. Eye (Lond) 2005; 19: 77-79 DOI: 10.1038/sj.eye.6701404.
- 17 John M, Chirayath S, Paulson S. Multiple soft fibromas of the lid. Indian J Ophthalmol 2015; 63: 262-264 DOI: 10.4103/0301-4738.156932.
- 18 Nair PA, Singhal R. Xanthelasma palpebrarum – a brief review. Clin Cosmet Investig Dermatol 2018; 11: 1-5 DOI: 10.2147/ccid.S130116.
- 19 Chang MW, Frieden IJ, Good W. The risk intraocular juvenile xanthogranuloma: survey of current practices and assessment of risk. J Am Acad Dermatol 1996; 34: 445-449 DOI: 10.1016/s0190-9622(96)90437-5.
- 20 Karcioglu ZA, Mullaney PB. Diagnosis and management of iris juvenile xanthogranuloma. J Pediatr Ophthalmol Strabismus 1997; 34: 44-51 DOI: 10.3928/0191-3913-19970101-10.
- 21 Samara WA, Khoo CT, Say EA. et al. Juvenile Xanthogranuloma Involving the Eye and Ocular Adnexa: Tumor Control, Visual Outcomes, and Globe Salvage in 30 Patients. Ophthalmology 2015; 122: 2130-2138 DOI: 10.1016/j.ophtha.2015.06.009.
- 22 Hernandez-Martin A, Baselga E, Drolet BA. et al. Juvenile xanthogranuloma. J Am Acad Dermatol 1997; 36: 355-367 DOI: 10.1016/s0190-9622(97)80207-1.
- 23 Bang GM, Setabutr P. Periocular capillary hemangiomas: indications and options for treatment. Middle East Afr J Ophthalmol 2010; 17: 121-128 DOI: 10.4103/0974-9233.63071.
- 24 Haik BG, Karcioglu ZA, Gordon RA. et al. Capillary hemangioma (infantile periocular hemangioma). Surv Ophthalmol 1994; 38: 399-426 DOI: 10.1016/0039-6257(94)90172-4.
- 25 Kopf AW, Bart RS. Tumor Conference #48. Massive congenital hemangioma resulting in death. J Dermatol Surg Oncol 1983; 9: 509-512 DOI: 10.1111/j.1524-4725.1983.tb00845.x.
- 26 Hsu J, Mohney BG. Infantile hemangiomas masquerading as other periocular disorders. Case Rep Pediatr 2012; 2012: 290645 DOI: 10.1155/2012/290645.
- 27 Jonas RA, Rokohl AC, Kakkassery V. et al. [Diagnostics of benign and malignant tumors of the orbit]. Ophthalmologe 2021; 118: 987-994 DOI: 10.1007/s00347-021-01429-x.
- 28 Ha A, Kim JS, Baek SU. et al. Facial Port-Wine Stain Phenotypes Associated with Glaucoma Risk in Neonates. Am J Ophthalmol 2020; 220: 183-190 DOI: 10.1016/j.ajo.2020.08.003.
- 29 Lee JW, Chung HY. Capillary Malformations (Portwine Stains) of the Head and Neck: Natural History, Investigations, Laser, and Surgical Management. Otolaryngol Clin North Am 2018; 51: 197-211 DOI: 10.1016/j.otc.2017.09.004.
- 30 Higueros E, Roe E, Granell E. et al. Sturge-Weber Syndrome: A Review. Actas Dermosifiliogr 2017; 108: 407-417 DOI: 10.1016/j.ad.2016.09.022.
- 31 Oke I, Alkharashi M, Petersen RA. et al. Treatment of Ocular Pyogenic Granuloma With Topical Timolol. JAMA Ophthalmol 2017; 135: 383-385 DOI: 10.1001/jamaophthalmol.2017.0110.
- 32 Khorsand K, Maier M, Brandling-Bennett HA. Pyogenic granuloma in a 5-month-old treated with topical timolol. Pediatr Dermatol 2015; 32: 150-151 DOI: 10.1111/pde.12297.
- 33 Wine Lee L, Goff KL, Lam JM. et al. Treatment of pediatric pyogenic granulomas using β-adrenergic receptor antagonists. Pediatr Dermatol 2014; 31: 203-207 DOI: 10.1111/pde.12217.
- 34 Nair AG, George RJ, Natarajan S. et al. Topical timolol for the treatment of conjunctival pyogenic granulomas: Outcomes and effect on intraocular pressure. Indian J Ophthalmol 2020; 68: 2170-2174 DOI: 10.4103/ijo.IJO_183_20.
- 35 DeMaria LN, Silverman NK, Shinder R. Ophthalmic Pyogenic Granulomas Treated With Topical Timolol-Clinical Features of 17 Cases. Ophthal Plast Reconstr Surg 2018; 34: 579-582 DOI: 10.1097/iop.0000000000001116.
- 36 Stagner AM, Jakobiec FA. Peripheral Nerve Sheath Tumors of the Eyelid Dermis: A Clinicopathologic and Immunohistochemical Analysis. Ophthal Plast Reconstr Surg 2016; 32: 40-45 DOI: 10.1097/iop.0000000000000424.
- 37 Chen N, Hsu YH, Lee YC. Solitary neurofibroma of eyelid masquerading as chalazion. Int Med Case Rep J 2017; 10: 177-179 DOI: 10.2147/imcrj.S136255.
- 38 Poonam NS, Alam MS, Das D. et al. Solitary eyelid neurofibroma presenting as tarsal cyst: Report of a case and review of literature. Am J Ophthalmol Case Rep 2018; 10: 71-73 DOI: 10.1016/j.ajoc.2018.02.002.
- 39 Avery RA, Katowitz JA, Fisher MJ. et al. Orbital/Periorbital Plexiform Neurofibromas in Children with Neurofibromatosis Type 1: Multidisciplinary Recommendations for Care. Ophthalmology 2017; 124: 123-132 DOI: 10.1016/j.ophtha.2016.09.020.
- 40 Ferner RE. Neurofibromatosis 1 and neurofibromatosis 2: a twenty first century perspective. Lancet Neurol 2007; 6: 340-351 DOI: 10.1016/S1474-4422(07)70075-3.
- 41 Chaudhry IA, Morales J, Shamsi FA. et al. Orbitofacial neurofibromatosis: clinical characteristics and treatment outcome. Eye (Lond) 2012; 26: 583-592 DOI: 10.1038/eye.2011.336.
- 42 de Oliveira ECV, da Motta VRV, Pantoja PC. et al. Actinic keratosis – review for clinical practice. Int J Dermatol 2019; 58: 400-407 DOI: 10.1111/ijd.14147.
- 43 Jayaprakasam A, Rene C. A benign or malignant eyelid lump–can you tell? An unusual collision tumour highlighting the difficulty differentiating a hidrocystoma from a basal cell carcinoma. BMJ Case Rep 2012; 2012: bcr1220115307 DOI: 10.1136/bcr.12.2011.5307.
- 44 Prabhakaran VC, Gupta A, Huilgol SC. et al. Basal cell carcinoma of the eyelids. Compr Ophthalmol Update 2007; 8: 1-14
- 45 Shi Y, Jia R, Fan X. Ocular basal cell carcinoma: a brief literature review of clinical diagnosis and treatment. Onco Targets Ther 2017; 10: 2483-2489 DOI: 10.2147/ott.S130371.
- 46 Madge SN, Khine AA, Thaller VT. et al. Globe-sparing surgery for medial canthal Basal cell carcinoma with anterior orbital invasion. Ophthalmology 2010; 117: 2222-2228 DOI: 10.1016/j.ophtha.2010.02.013.
- 47 Boeckmann L, Martens MC, Kakkassery V. et al. Molekulargenetische Untersuchungen als Basis zielgerichteter Therapien beim Basalzellkarzinom am Auge. Ophthalmologe 2020; 117: 106-112 DOI: 10.1007/s00347-019-0905-3.
- 48 Situm M, Buljan M, Bulat V. et al. The role of UV radiation in the development of basal cell carcinoma. Coll Antropol 2008; 32 (Suppl. 02) S167-S170
- 49 Hou X, Rokohl AC, Ortmann M. et al. Effective treatment of locally advanced periocular basal cell carcinoma with oral hedgehog pathway inhibitor?. Graefes Arch Clin Exp Ophthalmol 2020; 258: 2335-2337 DOI: 10.1007/s00417-020-04779-5.
- 50 Guo Y, Rokohl AC, Kopecky A. et al. Periocular basal cell carcinoma–current treatment concepts. Ann Eye Sci 2021; 6: 18
- 51 Rokohl AC, Koch KR, Mor JM. et al. [Personalized medicine in the treatment of periocular tumors: Targeted treatment and use of immune checkpoint inhibitors]. Ophthalmologe 2020; 117: 521-527 DOI: 10.1007/s00347-019-01034-z.
- 52 Kakkassery V, Heindl LM. Standardvorgehensweise bei Basalzellkarzinom am Auge. Ophthalmologe 2020; 117: 124 DOI: 10.1007/s00347-019-01019-y.
- 53 Warszawik-Hendzel O, Olszewska M, Maj M. et al. Non-invasive diagnostic techniques in the diagnosis of squamous cell carcinoma. J Dermatol Case Rep 2015; 9: 89-97 DOI: 10.3315/jdcr.2015.1221.
- 54 Garcia-Zuazaga J, Olbricht SM. Cutaneous squamous cell carcinoma. Adv Dermatol 2008; 24: 33-57 DOI: 10.1016/j.yadr.2008.09.007.
- 55 Liu V, Mihm MC. Pathology of malignant melanoma. Surg Clin North Am 2003; 83: 31-60 v DOI: 10.1016/s0039-6109(03)00003-3.
- 56 Harish V, Bond JS, Scolyer RA. et al. Margins of excision and prognostic factors for cutaneous eyelid melanomas. J Plast Reconstr Aesthet Surg 2013; 66: 1066-1073 DOI: 10.1016/j.bjps.2013.04.032.
- 57 Chan FM, OʼDonnell BA, Whitehead K. et al. Treatment and outcomes of malignant melanoma of the eyelid: a review of 29 cases in Australia. Ophthalmology 2007; 114: 187-192 DOI: 10.1016/j.ophtha.2006.08.043.
- 58 Tahery DP, Goldberg R, Moy RL. Malignant melanoma of the eyelid. A report of eight cases and a review of the literature. J Am Acad Dermatol 1992; 27: 17-21 DOI: 10.1016/0190-9622(92)70148-9.
- 59 Glatt HJ, Proia AD, Tsoy EA. et al. Malignant syringoma of the eyelid. Ophthalmology 1984; 91: 987-990 DOI: 10.1016/s0161-6420(84)34204-x.
- 60 Segal A, Segal N, Gal A. et al. Mucinous sweat gland adenocarcinoma of the eyelid – current knowledge of a rare tumor. Orbit 2010; 29: 334-340 DOI: 10.3109/01676830.2010.516469.
- 61 Shields JA, Demirci H, Marr BP. et al. Sebaceous carcinoma of the ocular region: a review. Surv Ophthalmol 2005; 50: 103-122 DOI: 10.1016/j.survophthal.2004.12.008.
- 62 Sousa Neves F, Braga J, Cardoso da Costa J. et al. Kaposiʼs sarcoma of the conjunctiva and the eyelid leads to the diagnosis of human immunodeficiency virus infection – a case report. BMC Cancer 2018; 18: 708 DOI: 10.1186/s12885-018-4611-3.
- 63 Hoerster R, Schlaak M, Koch KR. et al. [Merkel cell carcinoma of the eyelid. An often unrecognized tumor entity: Clinical aspects and treatment strategies]. Ophthalmologe 2017; 114: 134-139 DOI: 10.1007/s00347-016-0355-0.
- 64 North VS, Habib LA, Yoon MK. Merkel cell carcinoma of the eyelid: A review. Surv Ophthalmol 2019; 64: 659-667 DOI: 10.1016/j.survophthal.2019.03.002.
- 65 Amaral T, Leiter U, Garbe C. Merkel cell carcinoma: Epidemiology, pathogenesis, diagnosis and therapy. Rev Endocr Metab Disord 2017; 18: 517-532 DOI: 10.1007/s11154-017-9433-0.
- 66 Herbert HM, Sun MT, Selva D. et al. Merkel cell carcinoma of the eyelid: management and prognosis. JAMA Ophthalmol 2014; 132: 197-204 DOI: 10.1001/jamaophthalmol.2013.6077.
- 67 Svendsen FH, Heegaard S. Lymphoma of the eyelid. Surv Ophthalmol 2017; 62: 312-331 DOI: 10.1016/j.survophthal.2016.11.009.
- 68 Dhannawat SS, Sherwood C, Bahadur R. Eyelid metastasis from lung adenocarcinoma. Am J Ophthalmol Case Rep 2020; 20: 100991 DOI: 10.1016/j.ajoc.2020.100991.
- 69 Heichel J, Reich W, Stadie V. et al. [Interdisciplinary Management of Tumours of the Eyelid and Periorbital Region]. Klin Monbl Augenheilkd 2020; 237: 46-56 DOI: 10.1055/a-1082-1454.
- 70 Rokohl AC, Koch KR, Kabbasch C. et al. [Importance of interdisciplinary collaboration for optimal treatment of orbital tumors]. HNO 2019; 67: 528-533 DOI: 10.1007/s00106-019-0659-x.
- 71 Kersten RC, Ewing-Chow D, Kulwin DR. et al. Accuracy of clinical diagnosis of cutaneous eyelid lesions. Ophthalmology 1997; 104: 479-484 DOI: 10.1016/s0161-6420(97)30288-7.
- 72 Feldmann ML, Chankiewitz E, Sonntag SR. et al. [Benign Tumors of the Eyelid]. Klin Monbl Augenheilkd 2022; 239: 111-130 DOI: 10.1055/a-1671-0923.
- 73 Herwig-Carl MC, Löffler KU. [Eyelid Tumors: Clinical Aspects of Ophthalmic Pathology]. Klin Monbl Augenheilkd 2018; 235: 776-781 DOI: 10.1055/a-0633-3120.
- 74 Sendul SY, Akpolat C, Yilmaz Z. et al. Clinical and pathological diagnosis and comparison of benign and malignant eyelid tumors. J Fr Ophtalmol 2021; 44: 537-543 DOI: 10.1016/j.jfo.2020.07.019.
- 75 Leung C, Johnson D, Pang R. et al. Identifying predictive morphologic features of malignancy in eyelid lesions. Can Fam Physician 2015; 61: e43-e49
- 76 Thomas L, Tranchand P, Berard F. et al. Semiological value of ABCDE criteria in the diagnosis of cutaneous pigmented tumors. Dermatology 1998; 197: 11-17 DOI: 10.1159/000017969.
- 77 Friedman RJ, Rigel DS, Kopf AW. Early detection of malignant melanoma: the role of physician examination and self-examination of the skin. CA Cancer J Clin 1985; 35: 130-151 DOI: 10.3322/canjclin.35.3.130.
- 78 Hishmi AM, Koch KR, Matthaei M. et al. Modified Hughes procedure for reconstruction of large full-thickness lower eyelid defects following tumor resection. Eur J Med Res 2016; 21: 27 DOI: 10.1186/s40001-016-0221-1.
- 79 Kopecky A, Koch KR, Bucher F. et al. [Results of Cutler-Beard procedure for reconstruction of extensive full thickness upper eyelid defects following tumor resection]. Ophthalmologe 2016; 113: 309-313 DOI: 10.1007/s00347-015-0146-z.
- 80 Rokohl AC, Kopecky A, Guo Y. et al. [Surgical resection with ophthalmoplastic reconstruction: Gold standard in periocular basal cell carcinoma]. Ophthalmologe 2020; 117: 95-105 DOI: 10.1007/s00347-019-00973-x.
- 81 Rokohl AC, Löser H, Mor JM. et al. Junger Patient mit ungewöhnlicher Raumforderung am Unterlid. Ophthalmologe 2020; 117: 73-77 DOI: 10.1007/s00347-019-00948-y.
- 82 Bianciotto C, Demirci H, Shields CL. et al. Metastatic tumors to the eyelid: report of 20 cases and review of the literature. Arch Ophthalmol 2009; 127: 999-1005 DOI: 10.1001/archophthalmol.2009.120.
- 83 Defty C, Breitenfeldt N, Dhital SK. et al. Demodex folliculorum: a parasite infection mimicking skin cancer. J Plast Reconstr Aesthet Surg 2013; 66: 289-290 DOI: 10.1016/j.bjps.2012.08.028.