Atlas of Eyelid and Conjunctival Tumors Jerry A. Shields, M.D. Director, Ocular Oncology Service Wills Eye Hospital Professor of Ophthalmology Thomas Jefferson University Philadelphia, Pennsylvania Carol L. Shields, M.D. Surgeon, Ocular Oncology Service Wills Eye Hospital Associate Professor of Ophthalmology Thomas Jefferson University Philadelphia, Pennsylvania LIPPINCOTT WILLIAMS A Wolters Kluwer Company Philadelphia Baltimore New York London Buenos Aires Hong Kong Sydney Tokyo
Foreword xi Lorenz E. Zimmerman Preface > xiii Acknowledgments xv Part 1. Tumors and Pseudotumors of the Eyelids 1. Benign Tumors of the Epidermis 3 Papilloma 4 Seborrheic Keratosis 6 Inverted Follicular Keratosis 8 Pseudocarcinomatous Hyperplasia 10 Keratoacanthoma and Nonspecific Keratosis 12 2. Premalignant and Malignant Tumors of the Epidermis 17 Actinic Keratosis 18 Miscellaneous Premalignant Lesions of the Epidermis (Radiation Blepharopathy, Xeroderma Pigmentosum, and Sebaceous Nevus) 20 Basal Cell Carcinoma 22 Squamous Cell Carcinoma 32 3. Sebaceous Gland Tumors 37 Sebaceous Gland Hyperplasia and Adenoma 38 Sebaceous Gland Carcinoma 40 4. Sweat Gland Tumors 51 Syringoma 52 Eccrine Acrospiroma 54
viii Contents Syringocystadenoma Papilliferum 56 Pleomorphic Adenoma (Benign Mixed Tumor) of the Eyelid... 58 Sweat Gland Adenocarcinoma 60 5. Hair Follicle Tumors 63 Trichoepithelioma 64 Trichoadenoma and Trichofolliculoma 66 Trichilemmoma 68 Pilomatrixoma 70 6. Melanocytic Tumors 75 Melanocytic Nevus 76 Oculodermal Melanocytosis (Nevus of Ota) 82 Lentigo Maligna (Melanotic Freckle of Hutchinson) 84 Cellular Blue Nevus 88 Primary Malignant Melanoma of the Eyelid 92 7. Neural Tumors 95 Neurofibroma 96 Neurilemoma (Schwannoma) 98 Merkel Cell Carcinoma (Cutaneous Neuroendocrine Carcinoma). 100 8. Vascular Tumors 105 Congenital Capillary Hemangioma 106 Acquired Capillary Hemangioma (Cherry Hemangioma) 112 Nevus Flammeus 114 Miscellaneous Benign Vascular Tumors.-* 118 Kaposi's Sarcoma 120 Angiosarcoma 124 9. Lymphoid, Plasmacytic, and Metastatic Tumors 127 Lymphoma 128 Plasmacytoma 132 Metastatic Tumors 134 10. Histiocytic, Myxoid, and Fibrous Tumors 137 Xanthelasma and Xanthoma 138 Xanthogranuloma 140 Necrobiotic Xanthogranuloma with Paraproteinemia 142 Miscellaneous Histiocytic, Myxoid, and Fibrous Tumors 144 11. Cystic Lesions That Simulate Neoplasms 151 Eccrine Hidrocystoma 152 Apocrine Hidrocystoma 154 Sebaceous Cyst and Epidermal Inclusion Cyst 156 Dermoid Cyst 158 12. Inflammatory Lesions That Can Simulate Neoplasms 161 Viral Infections Molluscum Contagiosum 162 Granulomatous Disease Chalazion 164 Sarcoidosis, Pseudorheumatoid Nodule, and Wegener's Granulomatosis 166
ix Mycotic Infections Blastomycosis, Coccidioidomycosis, and Mucormycosis 168 Bacterial Infections Abscess and Necrotizing Fasciitis 170 13. Miscellaneous Eyelid Conditions That Can Simulate Neoplasms... 173 Amyloidosis 174 Lipoid Proteinosis 176 Miscellaneous Lesions Granular Cell Tumor, Malakoplakia, and Subepidermal Calcified Nodule 178 Phakomatous Choristoma 180 14. Tumors of the Lacrimal Drainage System 183 Squamous Tumors of the Lacrimal Drainage System 184 Malignant Melanoma of the Lacrimal Sac 186 Miscellaneous Benign Lesions of the Lacrimal Sac 188 15. Surgical Management of Eyelid Tumors 191 Surgical Management of Eyelid Tumors 192 Part 2. Tumors and Pseudotumors of the Conjunctiva 16. Choristomas _.^ 199 Dermoid and Dermolipoma 200 Epibulbar Osseous Choristoma 206 Lacrimal Gland and Respiratory Choristomas 208 Complex Choristoma 210 17. Benign Tumors of the Conjunctival Epithelium 213 Childhood Papilloma (Viral Papilloma) 214 Adulthood Papilloma 216 Pseudocarcinomatous Hyperplasia and Keratoacanthoma 218 Hereditary Benign Intraepithelial Dyskeratosis 220 Dacryoadenoma 222 18. Premalignant and Malignant Tumors of the Conjunctival Epithelium 225 Keratotic Plaque and Actinic Keratosis 226 Conjunctival Intraepithelial Neoplasia 228 Invasive Squamous Cell Carcinoma of the Conjunctiva 234 19. Melanocytic Tumors 243 Nevus 244 Primary Acquired Melanosis 252 Malignant Melanoma 256 20. Vascular Tumors 267 Pyogenic Granuloma 268 Lymphangiectasia and Lymphangioma 270 Varix, Capillary Hemangioma, and Cavernous Hemangioma... 272 Hemangiopericytoma and Kaposi's Sarcoma 274
21. Fibrous, Neural, Xanthomatous, and Myxomatous Tumors 277 Neurofibroma 278 Neurilemoma and Granular Cell Tumor 280 Fibrous Histiocytoma 282 Fibroma, Nodular Fasciitis, and Juvenile Xanthogranuloma 284 Myxoma, Lipoma, and Reticulohistiocytoma 286 22. Lymphoid, Leukemic, and Metastatic Tumors 289 Lymphoid Tumors of the Conjunctiva 290 Leukemia 294 Metastatic Tumors to the Conjunctiva 296 23. Tumors of the Caruncle 299 Tumors of the Caruncle 300 24. Lesions That Can Simulate Conjunctival Neoplasms 309 Epithelial Inclusion Cyst 310 Organizing Hematoma ("Hematic Cyst"; "Hematocele") 312 Foreign Bodies Simulating Conjunctival Neoplasms 314 Episcleritis and Scleritis Simulating Neoplasms 316 Ghurg-Strauss Allergic Granulomatosis Simulating Conjunctival Neoplasms 318 Ligneous Conjunctivitis 320 Miscellaneous Infectious Lesions That Simulate Neoplasms 322 Conjunctival Amyloidosis 324 Pingueculum and Pterygium 326 Miscellaneous Lesions That Simulate Pigmented Conjunctival Melanoma 328 25. Surgical Management of Conjunctival Tumors 331 Surgical Management of Conjunctival Tumors 332 Subject Index 335