A 62-year-old lady with an eyelid mass

A 62-year-old female from South Africa presented with watering and feeling of a lump in the left lower medial eyelid since 1 year [Figure 1]. The lesion was occluding the lower punctum, was extending to the caruncle, and had telangiectatic vessels on its surface.

Figure 1.

Eyelid lesion

Questions:

1. What is the likely diagnosis? Describe three features in support of your diagnosis.

2. What are the five differential diagnoses of umblicated lesions of the eyelid?

For answers please see page 153.

Answers

1. Diagnosis:

Nodular basal cell carcinoma, proven to be deeply infiltrative by histopathology [Figure 2]

Figure 2.

Histopathology

Three distinguishing features:

1. Pearly border

2. Induration

3. Telangiectasia

2.Differential diagnoses of umblicated eyelid lesion:

1. Basal cell carcinoma

2. Keratoacanthoma

3. Molluscum contagiosum

4. Sebaceous hyperplasia

5. Trichofolliculoma

• Basal cell carcinoma is the most common human malignancy and accounts for 90% of eyelid malignancies. It usually affects the elderly, white population between 50 and 80 years of age, with no sex predilection. Three percent of eyelid cases occur in patients under 35 years of age. It is slow-growing, classified as malignant because of its local invasiveness. The distribution of the tumor is lower eyelid 53%, medial canthus 30%, and upper eyelid 10%) and lateral canthus 5%. The types of BCC include nodular, ulcerative, noduloulcerative, cystic, morpheaform, and pigmented. The nodular form is more common. Early diagnosis is the key. The common forms of treatment include wide excision with frozen section control, cryotherapy, and radiotherapy in rare cases. Exenteration is necessary in less than 3% of cases due to orbital invasion. Death is rare and occurs due to intracranial extension in advanced or neglected cases.