For eyelid lesions, when in doubt, investigate further

WAILEA, Hawaii — When treatment for eyelid lesions is not working, investigate further to ensure malignancy is not the underlying etiology, Eli L. Chang, MD, FACS, said at Hawaiian Eye 2018.

The first key point to avoiding missing the diagnosis of a malignant lesion is to know the anatomy, Chang said. Then, “if your diagnosis doesn’t make sense, investigate further. If your treatment doesn’t work, you need to investigate further.”

Five percent to 10% of all skin cancers occur in the eyelid, and specificity for diagnosing skin cancer is 94% for ophthalmologists and 99% for dermatologists — a good solid “A,” Chang said.

However, what ophthalmologists do not do well is look for the malignancies, missing approximately one-third of all cancers, “which is appalling, considering how good we are at identifying them,” he said.

The most common malignant lesions are basal cell carcinoma, squamous cell carcinoma, sebaceous cell carcinoma and malignant melanoma, for which there are many available treatments.

“But it’s not worth anything if you can’t identify it,” he said. “The bottom line is that you really need to trust yourself, because statistically you are right. You know what it is already. If you really still don’t know, then biopsy it and follow up on the results.”

“Have your own opinion,” Chang said. “Just look for it. We cannot go on as a group missing one-third of all of these lesions.” – by Patricia Nale, ELS

 

Reference:

Source: Chang EL. Lumps and bumps: Keys to success with eyelid lesions. Presented at: Hawaiian Eye 2018; Jan. 13-19, 2018; Wailea, Hawaii.

 

Disclosure: Chang reports no relevant financial disclosures.