Orbit & Eyelid Tumors

Oculoplastics | Lisa A. Mansueto, M.D.

  1. Benign Eyelid Tumors
    1. Nevus – pigmented or non-pigmented; of skin or conjunctiva
    2. Seborrheic Keratosis – pigmented or non-pigmented; appear as if “stuck on” skin
    3. Papilloma– vascularized, papillary fronds
    4. Pyogenic Granuloma – inflammatory mass reaction due to either chronic rubbing ( for example, from prosthesis) or chronic lid inflammation (for example, from chalazion)
    5. 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.)
  2. Malignant Tumors of the Eyelid
    1. 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
    2. 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
    3. 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
    4. Malignant Melanoma – least common (about 1%); the greater the depth of invasion, the worse the prognosis; spread to local lymph
    5. Metastatic Disease – very uncommon; breast, cutaneous melanoma, lung, stomach, colon, thyroid, trachea, and parotid gland
  3. Benign Orbital Tumors
    1. Mucocoele – sinus tumors (mucous collection/cysts) that spread into orbit; usually remove as cause diplopia, proptosis
    2. Dermoid – most common benign tumor in children; usually remove as risk of rupture to cause severe inflammation
    3. Cavernous Hemangioma – most common benign tumor in adults; usually observe unless cause symptoms of severe proptosis, decreased vision (rare), or double vision (rare)
    4. Idiopathic Inflammatory Orbital Pseudotumor – acute onset of pain, diplopia, decreased vision; treat with steroids
    5. 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
  4. Malignant Orbital/Ocular Tumors
    1. Rhabdomyosarcoma – most common malignant tumor in children; often quickly growing; after biopsy, treatment includes chemotherapy and possible radiation
    2. Lymphoma – most common malignant tumor in adults; often localized to orbit; often excellent prognosis with radiation
    3. 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
    4. Metastatic Disease – breast, prostate, lung
    5. Ocular Melanoma – most common intraocular tumor in adults; might require eye removal (enucleation) and become metastatic to other organs in the body
    6. Ocular Retinoblastoma – most common intraocular tumor in children; might require chemotherapy and eye removal (enucleation)