Orbit & Eyelid Tumors

OCULOPLASTICS

Lisa A. Mansueto, M.D.

I. Benign Eyelid Tumors

A. Nevus - pigmented or non-pigmented; of skin or conjunctiva

B. Seborrheic Keratosis - pigmented or non-pigmented; appear as if "stuck on" skin

C. Papilloma- vascularized, papillary fronds

D. Pyogenic Granuloma - inflammatory mass reaction due to either chronic rubbing ( for example, from prosthesis) or chronic lid inflammation (for example, from chalazion)

E. Molluscum Contagiosum - caused by cutaneous pox virus; 1-5mm in diameter; classically with umbilicated center; chronic follicular conjunctivitis can be associated; often present in young children or immunocompromised patients (HIV, cancer, etc.)

II. Malignant Tumors of the Eyelid

A. Basal Cell Carcinoma - most common type (90%); correlated usually with sun exposure; most often located on lower eyelid (52%); rare hereditary disease (Basal Cell Nevus Syndrome); spreads by direct

B. Squamous Cell Carcinoma - second most common type (2-9%); possibly related to sun exposure; can spread locally and into lymphatic channels; also spreads along nerves into the orbit and brain

C. Sebaceous Cell Carcinoma - third most common type (2-7%); often difficult to diagnosis; often elderly patients; arises from meibomian glands or sebaceous glands of cilia, caruncle, or eyebrow; can present as chronic conjunctivitis, peduculated growth, or chalazion; spreads both locally and to distant organs such as lungs, liver, and brain; lesions greater than 2-cm have a 60% mortality rate; lesion involving both upper and lower eyelids have 83% mortality rate

D. Malignant Melanoma - least common (about 1%); the greater the depth of invasion, the worse the prognosis; spread to local lymph

E. Metastatic Disease - very uncommon; breast, cutaneous melanoma, lung, stomach, colon, thyroid, trachea, and parotid gland

III. Benign Orbital Tumors

A. Mucocoele - sinus tumors (mucous collection/cysts) that spread into orbit; usually remove as cause diplopia, proptosis

B. Dermoid - most common benign tumor in children; usually remove as risk of rupture to cause severe inflammation

C. Cavernous Hemangioma - most common benign tumor in adults; usually observe unless cause symptoms of severe proptosis, decreased vision (rare), or double vision (rare)

D. Idiopathic Inflammatory Orbital Pseudotumor - acute onset of pain, diplopia, decreased vision; treat with steroids

E. Lymphangioma - usually present at birth but might not show up unless hemorrhage occurs within the mass; usually observe; might need to debulk if cause proptosis or retro-orbital hemorrhage

IV. Malignant Orbital/Ocular Tumors

A. Rhabdomyosarcoma - most common malignant tumor in children; often quickly growing; after biopsy, treatment includes chemotherapy and possible radiation

B. Lymphoma - most common malignant tumor in adults; often localized to orbit; often excellent prognosis with radiation

C. Adenoid Cystic Carcinoma of Lacrimal Gland - rare malignant tumor; can occur in children or adults; often can be lethal due to distant metastatic spread; treatment is major surgery to exenterate orbit, followed by radiation

D. Metastatic Disease - breast, prostate, lung

E. Ocular Melanoma - most common intraocular tumor in adults; might require eye removal (enucleation) and become metastatic to other organs in the body

F. Ocular Retinoblastoma - most common intraocular tumor in children; might require chemotherapy and eye removal (enucleation)