Skin Cancer Diagnosis & Surgical Management *

Eyelid Lumps and Bumps - could it be cancer?

Cancerous Eyelid Pictures
Non-Cancerous Eyelid Pictures
Learn about Skin Cancer and Statistics

* This information is not meant to replace the advice of your physician and is not to be considered medical advice, diagnosis or treatment. Should you have any concern please contact your physician directly. Read our disclaimer

Cancerous

Basal Cell Carcinoma
	Basal Cell Carcinoma Cancerous
	Infiltrative Basal Cell Carcinoma Cancerous
	Medial Canthal Basal Cell Carcinoma Cancerous
	Ulcerative Basal Cell Carcinoma Cancerous
	Umbilicated Basal Cell Carcinoma Cancerous
	Non-pigmented Mole vs. Basal Cell Carcinoma Cancerous

Squamous Cell Carcinoma
	Cystic Squamous Cell Carcinoma Cancerous
	Squamous Cell Carcinoma Cancerous

Eyelid Melanoma
	Melanoma Cancerous

Sebaceous Cell Carcinoma
	Sebaceous Cell Carcinoma Cancerous
	Sebaceous Cell Carcinoma Cancerous

* This information is not meant to replace the advice of your physician and is not to be considered medical advice, diagnosis or treatment. Should you have any concern please contact your physician directly. Read our disclaimer

Non-Cancerous

Hemangioma
	Capillary Hemangioma Non-Cancerous
	Cavernous Hemangioma Non-Cancerous

Eyelid Cysts
	Eccrine Cyst Non-Cancerous
	Epithelial Inclusion Cyst Non-Cancerous

Trichofolliculoma
	Trichofolliculoma Non-Cancerous

Apocrine Hidrocystomas
	Apocrine Hidrocystomas Non-Cancerous

Compound Nevus
	Compound Nevus Non-Cancerous

Intradermal Nevus
	Intradermal Nevus Non-Cancerous

Keratoacanthoma
	Keratoacanthoma Non-Cancerous

Lentigo Maligna
	Lentigo Maligna Non-Cancerous

Papilloma
	Verruca Vulgaris Papilloma Non-Cancerous
	Papilloma Non-Cancerous

Seborrheic Keratosis
	Seborrheic Keratosis Non-Cancerous

* This information is not meant to replace the advice of your physician and is not to be considered medical advice, diagnosis or treatment. Should you have any concern please contact your physician directly. Read our disclaimer

Skin Cancer almost as common as all other cancers combined!

1.4 m new non-skin cancers in 2006

1.5 million new skin cancers this year*

• Basal cell carcinomas (80%)
• Squamous cell carcinomas (15%)
• Melanomas (4%)
• (Sebaceous cell carcinoma (1%))

Eyelid Oncology Listen Ask the right questions Look For warning signs Feel The region of interest

Classic Risk Factors

• Elderly Caucasian
• Light complexion/Blue eyes
• Actinic damage
• Cigarette Smoking

More than 90 % of Non-Melanoma Skin Cancer is Caused by Sun Exposure

• Unprotected exposure
• Outdoors even in the fog
• Tanning booths
• Through car, home or office windows
• Yet only 33% of women and 10% of men wear daily sunblock
• Learn More: www.skincancer.org

Risk Factors specific to Squamous Cell Carcinoma

• HPV 16 and 18
• Immunosuppression
• HIV – atypical, younger pts
• Organ transplant
• Xeroderma pigmentosum
• Autosomal recessive
• Predisposition for epithelial tumors

Incidence Of Skin Cancers in the Young

Incidence since:

• Melanoma has tripled
• Squamous cell carcinoma and basal cell carcinoma have doubled

Can present in second or third decade
1 in 5 Americans will be diagnosed with skin cancer (1 in 3 Caucasians)
Men: Women; 2 : 1

Watch Out: Skin Cancer Occurs in Non-Caucasians

Melanoma of the skin
Hispanic: birth to death risk
Male: .45 (1 in 221)
Female: .49 (1 in 205)

Melanoma of the Skin

 

Deaths Due to Skin Cancer

Skin Cancer MORE deadly for African Americans, Asians & Latinos

Caucasians

1974-1976: 81 %
1995-2001: 92 %

African Americans

1974-1976: 67%
1995-2001: 76%

Melanoma Surveillance, Epidemiology and End Results Program, 1975-2002, National Cancer Institute 2005; American Cancer Society, Surveillance Research, 2006

Five Year Survival Rates All races and both genders are combined

Skin Cancer Statistics United States

• Incidence of has tripled since 1980
• Early detection crucial !

The History - Ask the right questions

Have you had a prior skin cancer ?

• If history of BCCA -> 50% have second lesion at 5 years
• If history of SCCA -> 75% have second lesion at 5 years

Think beyond the face:

• Women: lower legs
• Men: back

Do you have:

• Pain ? (Usually painless)
• Intermittent scaling or scabbing ?
• Irritation when wearing glasses ?

American Cancer Association’s Look for warning signs ABCDE

A	Asymmetry - draw a line down the center
B	Border irregularity - Uneven, scalloped or notched
C	Color variations - Brown, tan, black mixed with red, white or blue
D	Diameter > pencil’s eraser

American Cancer Society’s Look for warning signs ABCDE

Evolution = NEW ANYTHING

• Grows or shrinks (suddenly)
• Irritation, redness
• Scaling
• Crusting, oozing or bleeding
• Tenderness or pain
  

Eyelid Specific Features Look for warning signs

Telangiectasis
Vessel blanching
Loss of lashes
Trichiasis
Hyperpigmentation
Hypopigmentation

Eyelid Specific Features Look for warning signs

• Eyelid malposition
• Ectropion
• Entropion
• Ptosis

Sebaceous Cell Carcinoma The Worst Offender

• Least common
• 50% misdiagnosed
• Average age: 72 years old
• Women: Men = 2:1
• Ectropion/entropion 10%
• Caruncle 5%
• Chronic conjunctivitis, cyst or pannus

Palpation is Important

• Feel the region of interest
• Firm
• Irregular
• Nodular
• Check for Lymph Nodes

SCCA	Melanoma
Preauricular, cervical nodes 4% Lung Bone Brain	Regional lymph nodes Liver Brain Bone

Biopsy Options

• Punch biopsy
• Pentagonal wedge
• Conjunctival mapping
• Mohs
• Skin Only – beware of what lies at the base of a cutaneous horn
  

SCCA Treatment

Surgical resection: 2-3 mm margins
If conjunctiva involved

• cryotherapy base, borders
• If incomplete excision (MMC/5FU)

Most recur within 2 – 5 years
Recurrence rate 5% to 41%

Melanoma – the bad guy

4% of skin cancer cases
75 % of skin cancer deaths
New cases have tripled since 1980
2006 estimate*:

• 62,190 new cases diagnosed
• 7,910 people will die of this disease

*American Cancer Society estimates based on data compiled by NCHS for 1930-2002 and population data from the US Census Bureau

Unfavorable Features
Tumor thickness > 1.8 mm
Lymphatic invasion
Unfavorable locations

• Caruncle
• Palpebral conjunctiva, fornix
• Cornea

Malignant Melanoma

• Frozen sections not possible
• 5 mm margin
• Sentinel node biopsy may improve early detection of lymph node involvement
• Lymph node # -> survival prognosis
• Vaccines not effective
• Spontaneous resolution bad

Melanoma – 5 year survival

• Overall: 91.6 %
• Localized: 98.3 %
• Regional: 63.8 %
• Distant spread: 16 %

Classic Melanoma Staging

Stage I and II > 1 mm thick	Sentinel node biopsy indicated
Stage III	Interferon used as adjunct
Stage IV	Think clinical trial

Conclusion

ABCDE too simplistic	Eyelids have their own special clues
Always send a specimen	If the answer doesn’t make sense; don’t believe it and re-biopsy
Wear Sunblock

* This information is not meant to replace the advice of your physician and is not to be considered medical advice, diagnosis or treatment. Should you have any concern please contact your physician directly. Read our disclaimer