Malignant Tumours

Basal Cell Carcinoma

This is the most common malignant tumour of the lids, usually occurring on the lower lid. It appears as a small lump, which tends to bleed, forming a central crust with a slightly raised hard surround. The tumour is locally invasive only but should be excised to avoid spread into bone. Even large lesions can be approached surgically (Figure 5.14) and "Mohs" micrographic surgery is recognised as a tissue-sparing goldstandard approach in many centres. Radiotherapy is only occasionally used with a greater risk of recurrence than formal surgical excision.

Squamous Cell Carcinoma

This tends to resemble basal cell carcinoma and biopsy is needed to differentiate. It can also be mimicked by a benign self-healing lesion known as keratoacanthoma.

Figure 5.14. Cystic basal cell carcinoma that has extended to involve most of the upper eyelid.CD

Malignant Melanoma

This raised black-pigmented lesion is highly malignant, but rare.

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