Aprile Vol.2 N° 1 - 2006 - Salute per tutti

1° Corso ISPLAD, Milano 2005
Lucia Brambilla
Vinicio Boneschi
Antonella Amoruso
Biancamaria Scoppio
Istituto di Scienze Dermatologiche,
Fondazione IRCCS Ospedale Maggiore Policlinico,
Mangiagalli e Regina Elena,
Università degli Studi di Milano
Patologia tumorale delle palpebre
SUMMARY
Neoplastic lid diseases
A lot of tumour can localize on the eyelids and be a source of great worry for the patient
because of both the aesthetic implications and their interference with mechanical function
and sight. Moreover benign neoplasms can be a manifestation of systemic diseases.
Benign neoplasms
The most common lesion is seborrheic keratosis. Palpebral syringoma or hidroadenoma, a
tumour of the eccrine ducts, often appears with multiple lesions especially on and near the
lower eyelid.
Nodular appendage tumours with differentiation towards hair such as trichoepithelioma,
trichilemmoma and pilomatricoma may occasionally involve the eyelids; the differential
diagnosis is difficult and need a histological examination.
Eccrine or apocrine hydrocystomas appear as papulo-nodular lesions on the rim of the
eyelid.
Melanocytic naevi are occasionally present on the eyelid, the conjunctiva or the sclera. A
peculiar congenital melanocytic nevus located on both the superior and inferior eyelid is
naevus disjunctus. The unilateral Ota nevus is a dermic melanocytosis of the face which
follows the area of the trigeminus innervation and frequently involves the ocular structures.
Among hemangiomas, the cavernous form, when affecting the eyelids, can cause
damages also to the eyeball and must be treated by local and systemic steroids, embolisation
and laser therapy.
Xanthelasma, in the form of elongated, yellowish patches, occurs selectively on the eyelids;
it may be associated with familiar hypercholesterolemy and can be removed in different
ways for aesthetic reasons.
Malignant tumours
Basal cell carcinoma (BCC) and sebaceous carcinoma (SebC) frequently arise in the eyelid,
whereas solar keratosis (SC), squamous cell carcinoma (SqC) and lentigo maligna
melanoma (LMM), all of them chronic sun damage-related, less frequently primitively
affect the eyelids because the upper one is in a more retracted position while and the lower
one is hit by sun’s rays at a very oblique angle. These neoplasms can, on the other hand,
extend to the eyelid starting from a primitive location in the periocular region.
The BCC constitutes 80-95% of malignant tumours of the eyelid and in 70% of cases is situated
in the lower lid and medial cantus. It gradually enlarges destroying adjacent structures.
Very rarely it spreads to regional nodes. Surgery is the best treatment; sometimes it
is very difficult to achieve a complete cure because the borders are difficult to appreciate.
Roentgentherapy is of value in selected cases, although not for the fibrosing variant.
SqC is the second most common tumour of the eyelid region (around 9%).
It generally originates from a precancerous state such as solar keratosis. Metastasis is relatively
frequent to regional nodes. Again, surgery is the best treatment, and in some cases
also roetgentherapy.
SebC occurs in the eyelids in 75% of cases from Meibonian glands, glands of rim or caruncola,
or indeterminate sites. It particularly affects the upper eyelids and frequently takes the
appearance of a chalazion, a BCC, a blepharitis or other inflammatory diseases. If not diagnosed
early, it runs an aggressive course with frequent regional and distant metastasis.
MM rarely occurs on the eyelids: it only represents 0.2-0.4% of malignant lesions. The
prognosis is worse when the neoplasm involves the rim of the eyelid and the conjunctiva.
Lentigo maligna (LM) is a superficial spreading MM in chronically damaged skin such as
the face; before becoming invasive it slowly extends in many years possibly affecting the
eyelids.Given the aesthetic and functional importance of the eyelids, any neoplasm in such
area must be diagnosed and eradicated as quickly as possible to ensure the best functional
and aesthetic results.
KEY WORDS: Eyelid, Benign neoplasms, Malignant tumours
Journal of Plastic Dermatology 2006; 2, 1 55