1. MALIGNANT EYELID TUMOURS 1. Basal cell carcinoma 2. Squamous cell carcinoma 3. Meibomian gland carcinoma 4. Melanoma 5. Kaposi sarcoma 6. Merkel cell carcinoma 7. Treatment

2. Basal Cell Carcinoma - Important Facts 1. Most common human malignancy 2. Usually affects the elderly 3. Slow-growing, locally invasive 5. 90% occur on head and neck 6. Of these 10% involve eyelids 7. Accounts for 90% of eyelid malignancies 4. Does not metastasize

3. Frequency of location of basal cell carcinoma Lower lid - 70% Medial canthus - 15% Upper lid - 10% Lateral canthus - 5%

5. Ulcerative basal cell carcinoma (rodent ulcer) Early Chronic ulceration Advanced Raised rolled edges and bleeding

7. Histology of basal cell carcinoma Downgrowth from epidermis of small, dark atypical basal cells Peripheral palisading Cell nests in fibrous stroma

9. Prominent nuclei and abundant acidophilic cytoplasm Variable sized groups of atypical epithelial cells within dermis Histology of squamous cell carcinoma Keratin ‘pearl’

11. Histology of meibomian gland carcinoma Cells stain positive for fat Cells contain foamy vacuolated cytoplasm and large hyperchromatic nuclei

16. Lower eyelid reconstruction following tumour excision Mustarde cheek rotation flap for large defect Tenzel flap for moderate defect Direct closure of small defect a b a b b

17. Eyelid-sharing procedure Reconstruction of posterior lamella Extensive sclerosing BCC Total excision of lower lid Tarsoconjunctival flap Reconstruction of anterior lamella with skin graft Appearance after healing