Clinical Medicine: Ocular Manifestations Associated with Dermatological Conditions II

4%

What is the metastasis rate of SCC (Squamous Cell Carcinoma)?

BCC (Basal Cell Carcinoma)

What is the most common cancer in humans?

Superficial

What is the most common clinical subtype of melanoma?

Lower Eyelid

What is the most common location of ocular SCC (Squamous Cell Carcinoma) appearance?

SCC (Squamous Cell Carcinoma)

What is the most common skin cancer in humans?

Lipofuscin

What is the orange pigment on the surface of this lesion?

8%

What is the recurrence rate of SCC (Squamous Cell Carcinoma)?

Nodular

What is the second most common clinical subtype of melanoma?

Actinic Keratosis

What is the term for the scaly 2-6 mm lesion that is a precursor to SCC (Squamous Cell Carcinoma)?

Local Tissue Destruction

What is typically the most significant clinical problem with a BCC (Basal Cell Carcinoma)?

>2

How many different colors on a lesion raise suspicion for malignancy?

q1 year

How often should a patient with a lesion that is 2 mm in diameter return to the clinic for a follow up if they are an established patient and the lesion has been stable?

q6 mos

How often should a patient with a lesion that is 2 mm in diameter return to the clinic for a follow up if they are new to the office?

q4-6 mos

How often should a patient with a lesion that is 2-2.5 mm in diameter return to the clinic if they have 1 to 2 risk factors for progression to malignancy?

4 mm

How wide should the margins be on a surgical excision of a BCC (Basal Cell Carcinoma)?

Uvea, Conjunctiva, Lacrimal Gland, & Eyelid

What are the more likely locations for a primary ocular melanoma to appear?

Nodular

What clinical subtype of melanoma appears as a uniformly dark, brown-blue or bluish-red raised de novo lesion that presents the possibility of evolving with a vertical growth pattern that invades into the skin?

Nodular, Pigmented, Superficial, Morpheaform, & Basosquamous

What are the clinical subtypes of systemic BCC (Basal Cell Carcinoma)?

Superficial

What clinical subtype of melanoma is most commonly associated with pre-existing nevi?

Cell Death & Metabolic Activity

What does the orange pigment on the surface of this lesion indicate?

Cutaneous Nevi, Cutaneous Freckles, Iris Nevi, & Choroidal Nevi

What factors pose an increased risk for ocular melanoma?

Pearly Margins & Telangiectasia

What is absent in an ulcerated SCC (Squamous Cell Carcinoma) that is present in a rodent ulcer to help in differentiation of SCC vs. BCC (Basal Cell Carcinoma)?

Melanoma

What is considered to be the most dangerous type of skin cancer?

Mohs (Micrographic Surgery w/or w/o radiotherapy), Extenteration (w/ or w/o radiotherapy), Smoothened Inhibitor Drugs, & Radiotherapy

What are the treatment options for a patient with orbital invasion of an eyelid BCC (Basal Cell Carcinoma)?

Surgical Excision, Radiotherapy, Smoothened Inhibitor Drugs, & Platinum Based Chemotherapy

What are the treatment recommendations for a patient with locally advanced or metastatic non-melanoma skin cancers?

Mohs (Micrographic Surgery)

What are the treatment recommendations for a patient with primary high risk non-melanoma skin cancers?

Curettage, Electrodessication, Surgical Excision, & Histological Assessment

What are the treatment recommendations for a patient with primary low risk non-melanoma skin cancers?

8.5 years

What is the mean duration of time from the initial diagnosis of a periorbital BCC (Basal Cell Carcinoma) to time of orbital invasion?

Red-Free

A choroidal nevus will disappear with use of what kind of light?

Orbital Periosteum

An Ocular BCC (Basal Cell Carcinoma) of the medial canthus is likely to infiltrate the orbit or globe through what structure?

Medial Canthus

An Ocular BCC (Basal Cell Carcinoma) tends to have higher incidence of orbit or globe infiltration if it is located in what part of the eye?

SCC (Squamous Cell Carcinoma)

Arsenic exposure is a risk factor for what type of skin cancer?

6 mm

At what size does a lesion become suspicious for malignancy?

Location (Eyelids, Ears, or Lips), Size (2 cm or more in diameter), Depth (Deep Invasion), & Perineural Extension

What are the major risk factors for recurrence & metastasis of SCC (Squamous Cell Carcinoma)?

Noduloulcerative (Rodent Ulcer)

If a nodular BCC (Basal Cell Carcinoma) presents with central necrosis, what is it called?

Perineural Extension

If a patient has a SCC (Squamous Cell Carcinoma) that is painful or itchy, or causes alteration in sensation it should raise concern for what?

Referral

If your patient has a lesion that is 2-2.5 mm in diameter & >3 risk factors for progression to malignancy how should they be managed?

16 & 18

Infection with which types of papilloma virus increase risk of developing SCC (Squamous Cell Carcinoma)?

Lower Eyelid

Ocular BCC (Basal Cell Carcinoma) tends to have a predilection for what location on the eye?

5-10%

Periocular SCC (Squamous Cell Carcinoma) comprises what percent of eyelid tumors?

Prolonged; Horizontal

To tell the difference between LM (Lentigo Malinga) and LMM (Lentigo Malinga Melanoma), remember that LM is a lesion that has ______________(invasive/prolonged) _______________ (horizontal/vertical) growth.

Invasive; Vertical

To tell the difference between LM (Lentigo Malinga) and LMM (Lentigo Malinga Melanoma), remember that LMM has _____________(invasive/prolonged) _______________ (horizontal/vertical) growth.

Superficial

What BCC (Basal Cell Carcinoma) subtype is found mostly as erythematous lesions on the trunk, and is often misdiagnosed as eczema?

Morpheaform

What BCC (Basal Cell Carcinoma) subtype is ivory or white in appearance, resembling a scar without any trauma and is a more aggressive form of BCC?

Nodular

What BCC (Basal Cell Carcinoma) subtype is the most common, frequently presenting on the head & neck as a translucent papule with telangiectasia & rolled borders?

Pigmented

What BCC (Basal Cell Carcinoma) subtype presents with dark colored melanin in the papules it produces?

Asymmetry, Border, Color, Diameter, & Evolution

What are the ABCs when comparing benign lesions vs. malignancy?

Nodular, Ulcerating, Cutaneous Horn,

What are the clinical subtypes of SCC (Squamous Cell Carcinoma)?

Nodular, Superficial, LM (Lentigo Maligna) LMM (Lentigo Malinga Melanoma), & ALM (Acral Lentiginous Melanoma)

What are the clinical subtypes of melanoma?

3-5%

What percent of periocular Sebaceous Cell Carcinomas progress to invasive carcinoma?

90%

What percentage of skin-cancer related mortality is due to cutaneous melanoma?

>15 mm

What size qualifies a choroidal nevus as "large"?

10-15 mm

What size qualifies a choroidal nevus as "medium"?

<10 mm

What size qualifies a choroidal nevus as "small"?

Surrounding Nerves, EOMs, Lacrimal Sac, Ethmoid Sinus, Cribriform Plate & (or) Superior Orbital Fissure (with resultant spread to the cavernous sinus or cerebral tissue)

What structures tend to become involved if an ocular BCC (Basal Cell Carcinoma) infiltrates the orbit or globe?

Nodular

What subtype of ocular BCC (Basal Cell Carcinoma) can take 1-2 years to reach 0.5 cm in diameter?

Morpheaform

What subtype of ocular BCC (Basal Cell Carcinoma) is less common, and difficult to diagnose because margins are hard to delineate and the lesions tend to be much more extensive on palpation than visual inspection?

BCC (Basal Cell Carcinoma)

What type of cancer comprises 80%-95% of all eyelid & medial canthus malignancies, and typically presents in the nodular or morphoeic subtypes?

CHRPE

What type of lesion appears in this image?

Choroidal Nevi

What type of lesion appears in this image?

ALM (Acral Lentiginous Melanoma)

What type of melanoma is the most common subtype to appear in darker skinned individuals?

Noduloulcerative (Rodent Ulcer)

What type of ocular BCC (Basal Cell Carcinoma) has potential to erode large portions of the eyelid over time?

Soles of the Feet, Palms, & Subungual

Where are ALMs (Acral Lentiguous Melanomas) most commonly located?

Upper Back

Where do superficial spreading melanomas most commonly appear on men?

Lower Extremities

Where do superficial spreading melanomas most commonly appear on women?

Choroid

Where is the most common location for primary intraocular melanoma to appear?

Cutaneous Horn

Which clinical subtype of SCC (Squamous Cell Carcinoma) is a wavy, scaly, and slightly raised non-cancerous skin growth that commonly arises from a seborrheic keratosis lesion & is indicative of underlying invasive disease?

Nodular

Which clinical subtype of SCC (Squamous Cell Carcinoma) may present with crusting, erosions, or fissures?

Ulcerating

Which clinical subtype of SCC (Squamous Cell Carcinoma) presents with a red base, & sharply defined, indurated & everted borders?

Supraorbital

Which nerve is most likely to be affected by perineural invasion of SCC (Squamous Cell Carcinoma)?