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Lumps, Bumps and Lid Lesions Know When to Hold Them & Know When to Fold Them Disclosures Cancer Cancer Cancer Cancer

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Lumps, Bumps and Lid Lesions Know When to Hold Them & Know When to Fold Them Disclosures Cancer Cancer Cancer Cancer 8/1/2016 Lumps, Bumps and Lid Lesions Disclosures Know when to hold them & Financial disclosures: The content o this COPE accredited CE activity was prepared independently by Dr. Robert E. Prouty without input rom members o know when to fold them the ophthalmic community. COPE #47629-SD Dr. Robert E. Prouty is a iliated with the ollowing companies as a member or their Speaker’s Bureau or as a Consultant but has no direct inancial or proprietary Robert E. Prouty, O.D., FAAO interest in any companies, products or services Specialty Eye Care mentioned in this presentation: VAlcon ) Allergan ) Optovue ) *eiss Meditec - ,SP - Parker, Co B-. ) Ivantis [email protected] The content and ormat o this course is presented without commercial bias and doesn’t claim superiority o any commercial product or service. Cancer Cancer De initions: Characteristics: ) A group o diseases characterized by ) Can af ect any tissue or organ at any age uncontrolled growth and spread o 5667 o all cancers occur in patients 8 55 yo abnormal cells ) American Cancer Society. Cancer Facts & Figures 2008 . Atlanta: American ) All cancers begin with a de ect in a single Cancer Society; 2008 cell (monoclonal) ) Any o various malignant neoplasms characterized by the proli eration o ) This is followed by unrestrained growth anaplastic cells that tend to invade Benign tumors may damage localized tissue surrounding tissue and metastasize to by occupying space but they do not spread new body sites ) www.dictionary.com Cancer Cancer Characteristics: Characteristics: ) Malignant tumors invade surrounding ) Malignant tumors invade surrounding tissue and may metastasize tissue and may metastasize A one cm tumor contains one billion cells A one cm tumor contains one billion cells One trillion cells usually means a lethal tumor One trillion cells usually means a lethal tumor ) Cell division is controlled by genes that ) Cell division is controlled by genes that promote it and genes that suppress it promote it and genes that suppress it Cancer is the result o some combination o Cancer is the result o some combination o de ects in this genetic unctioning de ects in this genetic unctioning 1 8/1/2016 History Cancer Risk actors: Duration ) Only 597 o cancers are strongly hereditary Bleeding ) Environmental factors account for 697-437 Discharge Tobacco Change in size Poor nutrition Obesity Change in color In ectious agents History o skin cancer Sunlight/Radiation Carcinogens Cancer Cancer Risk actors: Risk actors: ) Sunlight/Radiation ) Sunlight/Radiation .indqvist PG, Epstein E, et al. J Intern Med. 2016 .indqvist PG, Epstein E, et al. J Intern Med. 2016 Mar 16 Mar 16 ) Consmokers who stayed out o the sun had a li e eDpectancy ) Consmokers who stayed out o the sun had a li e eDpectancy similar to smokers. similar to smokers. ) “We ind an increased risk o Gskin cancer. However, the skin ) “We ind an increased risk o Gskin cancer. However, the skin cancers that occurred in those eDposing themselves to the sun cancers that occurred in those eDposing themselves to the sun had a better prognosis.” had a better prognosis.” ) Smokers eDposed to the sun lived 52 yrs longer than ) Smokers eDposed to the sun lived 52 yrs longer than non-sun eDposed nonsmokers non-sun eDposed nonsmokers Cancer Cancer The 5 leading non-skin cancers in the I.S. The 5 leading non-skin cancers in the I.S. ) Prostate ) Prostate ) .ung (90% in tobacco use) ) .ung (90% in tobacco use) ) Breast ) Breast ) Colo-rectal ) Colo-rectal ) Irinary/bladder ) Irinary/bladder Cancer accounts or 297 o the deaths in Cancer accounts or 297 o the deaths in the I.S. the I.S. ) 297 o people will be personally ) 297 o people will be personally af ected in their li etime af ected in their li etime 2 8/1/2016 Cancer Cancer Basal Cell Carcinoma :BCC) Basal Cell Carcinoma :BCC) ) The most common malignancy in humans ) 437 o BCC cases are on the head & neck ) 937 o all I.S. cancer, is skin cancer A97 on the trunk 437 o that is BCCK ) Greater risk o recurrence o BCC on ) Greater risks eDist for BCC & SCC in eyelids (lower), nose & ears patients: ) There is no precursor to BCC White ) 19L greater whites:blacks .ight colored eyes - hair Freckle easily and tan poorly Increases with I, eDposure ) Tanning beds M 1.5L relative risk Cancer Cancer Basal Cell Carcinoma :BCC) Basal Cell Carcinoma :BCC) ) 437 o BCC cases are on the head & neck ) 237 o all eyelid neoplasms A97 on the trunk 90% o all malignant eyelid neoplasms ) Greater risk o recurrence o BCC on ) Spread is by local invasion :almost eDclusively) eyelids (lower), nose & ears Nodular Superficial • Morpheaform Cancer Cancer Basal Cell Carcinoma :BCC) Basal Cell Carcinoma :BCC) ) 237 o all eyelid neoplasms ) 237 o all eyelid neoplasms 90% o all malignant eyelid neoplasms 90% o all malignant eyelid neoplasms ) Spread is by local invasion :almost eDclusively) ) Spread is by local invasion :almost eDclusively) 3 8/1/2016 16 weeks of Erivedge , 16 weeks of 1arceva , -Erlotinib0 -.ismodegib0 Basal Cell Nevus Syndrome (Gorlin-Goltz Syndrome) Source: Yin VT, Pfeiffer ML, Esmaeli B: Targeted therapy for orbtial and periocular basal cell carcinoma and squamous cell carcinoma. Source: Yin VT, Pfeiffer ML, Esmaeli B: Targeted therapy for orbtial and periocular basal cell carcinoma and squamous cell carcinoma. Ophthalmic Plastic and Reconstructive Surgery 2013;29(2):87-92 Ophthalmic Plastic and Reconstructive Surgery 2013;29(2):87-92 Cancer Cancer Squamous Cell Carcinoma :SCC): Squamous Cell Carcinoma :SCC): ) SCC is increasing in incidence – 2 nd most common eyelid malignancy Greater rate o increase or SCC vs BCC 10% of all eyelid malignancy ) 2007 or SCC vs 807 or BCC – Demographics ) Estimated BCC:SCC = 4:1 Older population SCC is most common skin cancer in blacks :O37) Fair complexion, sun damage ) B37 o cutaneous SCC occurs on the head & – Intraepithelial spread or deep invasion with neck (sun-eDposed) potential rare regional lymph node metastasis 90% o head - neck cancer M SCC Cancer Cancer Squamous Cell Carcinoma :SCC): SCC vs BCC: ) Risks: ) SCC grows faster, ulcerates, bleeds & Cumulative I,-B eDposure is the primary risk scabs more than BCC actor ) SCC recurs more frequently that BCC ) I,-A is less indicated but data is unclear Since SCC eDtends deeper :not local), more Smoking M 2L risk severe Tanning beds M 2.9L risk .esions on the ear - lips are at greater risk or Born in high I, eDposure area M OL risk recurrence .ight skin - hair M 2-9L risk ) Scalp, orehead, temple, eyelid, nose and hands are close behind Outdoor occupation M 9L risk 4 8/1/2016 Cancer Cancer SCC vs BCC: SCC vs BCC: ) SCC grows faster, ulcerates, bleeds & ) SCC grows faster, ulcerates, bleeds & scabs more than BCC scabs more than BCC ) SCC recurs more frequently that BCC ) SCC recurs more frequently that BCC Since SCC eDtends deeper :not local), more Since SCC eDtends deeper :not local), more severe severe .esions on the ear - lips are at greater risk or .esions on the ear - lips are at greater risk or recurrence recurrence ) Scalp, orehead, temple, eyelid, nose and hands are ) Scalp, orehead, temple, eyelid, nose and hands are close behind close behind SCC- Conjunctival • Inrelated to sun eDposure • Commonly misdiagnosed as conPunctivitis • Higher incidence o metastatic disease i lesion eDtends into orniD Cancer Cancer Solar lentigo Seborrheic keratosis ) Benign sun-induced area o darkening ) Common benign skin lesion in older adults pigmentation ) Proli eration o epidermal cells occurring Commonly re erred to as E.iver SpotH on sun eDposed areas o skin Easily mistaken or melanoma 5 8/1/2016 Cancer Cancer Seborrheic keratosis Malignant Melanoma :MM): ) Common benign skin lesion in older adults ) Increasing incidence :5B7 per year) ) Proli eration o epidermal cells occurring Greatest incidence increase amongst neoplasms on sun eDposed areas o skin Q the incidence o MM is between 35-65 ages ) 807 o cases occurring between 20-7N ages ,ariable pigmentation ) Pink ) brown ) dark brown ) black Survivability has improved ) 607 in 1960’s Can transition to solar lentigo ) 8897 in 1990’s ) Isually begin as lat, brown, circumscribed Median age o diagnosis is 57 areas that can increase in size and thickness Causes suspicion or melanoma Cancer Cancer Malignant Melanoma :MM): Malignant Melanoma :MM): ) Increasing incidence :5B7 per year) ) Increasing incidence :5B7 per year) Greatest incidence increase amongst neoplasms Greatest incidence increase amongst neoplasms Q the incidence o MM is between 35-65 ages Q the incidence o MM is between 35-65 ages ) 807 o cases occurring between 20-7N ages ) 807 o cases occurring between 20-7N ages Survivability has improved Survivability has improved ) Stage 2A4 The 5-year survival rate is around 977. The 10- ) Stage 22A4 The 5-year survival rate is around 817. The 10- year survival is around 957. year survival is around 677. ) Stage 2B4 The 5-year survival rate is around 927. The 10- ) Stage 22B4 The 5-year survival rate is around 707. The 10- year survival is around 867. year survival is around 577. ) Stage 22C4 The 5-year survival rate is around 537. The 10- year survival is around N07. Cancer Cancer Malignant Melanoma :MM): Malignant Melanoma :MM): ) Increasing incidence :5B7 per year) ) Increasing incidence :5B7 per year) Greatest incidence increase amongst neoplasms Greatest incidence increase amongst neoplasms Q the incidence o MM is between 35-65 ages Q the incidence o MM is between 35-65 ages ) 807 o cases occurring between 20-7N ages ) 807 o cases occurring between 20-7N ages Survivability has improved Survivability has improved ) Stage 222A4 The 5-year survival rate is around 787.
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