Eyelid and Orbital Oncology

When Does a Skin Tags, Lump or Bump Warrant a Biopsy?

When Does a Skin Tags, Lump or Bump Warrant a Biopsy?        Dr. Cockerham PDF thumbnail eyelid and orbital oncology

Skin tags can occur in childhood but become more common as one ages. Additionally, they are subject to hormonal changes and pregnant women experience new skin tags. Skin tags are typically an aesthetic concern and do not cause any further problems. However, they may have a relationship to diabetes and obesity so you should have your blood sugar and weight checked by your primary care physician if you notice a sudden onset of many skin tags.

Fortunately, skin tags are simple to remove. Usually these are removed using handheld cautery. In some cases excision is required with the use of a scalpel or special scissors. Control of bleeding and infection is extremely important. Therefore, only a physician should remove skin tags; do not try to do this on your own at home.

Any suspicious bump on or near your eyelid should be examined. There are a number of warning signs that indicate that the bump may be a skin cancer. These include the “ABCDEs:”

  • A: Asymmetry
  • B: Borders are irregular
  • C: Color variation (more than one color, new hypopigmentation (white discoloration) or hyperpigmentation (brown discoloration)
  • D: Diameter (size is greater than a pencil eraser)
  • E: Evolution (anything new – growth, bleeding, itching, loss of eyelashes, eyelashes in the wrong location)

Not all bumps are cancer. It may be a benign growth, infection or a sign of an underlying condition. Usually removal of the bump can be performed right in the office using a local anesthetic. Other cases require the equipment and safety of an operating room. After the bump is removed, you will likely be asked to apply an antibiotic ointment to prevent infection.

Eyelid Reconstruction for Cancer

Eyelid Reconstruction for Cancer

The four most common cancer of the eyelids are basal cell carcinoma, squamous cell carcinoma, melanoma, and sebaceous cell carcinoma. Basal cell carcinoma is the most common eyelid cancer and sun exposure is the largest risk factor.

During your consultation with Dr. Cockerham, she will provide informed consent, answer your questions and schedule a biopsy of your suspicious bump and send it to a laboratory for histopathologic examination. If skin cancer is present, additional excision may be needed. Dr. Cockerham works in conjunction with MOHS dermatologists to obtain free margins and then reconstruct the affected eyelids. Depending on the type of cancer, additional treatments (radiation or chemotherapy) may be needed.

Skin Cancer: By the Numbers

  • Skin cancer is the most common form of cancer in the United States
  • Each year there are more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung and colon
  • One in five Americans will develop skin cancer in the course of a lifetime
  • Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the two major forms of non-melanoma skin cancer
    • Between 40 and 50 percent of Americans who live to age 65 will have either skin cancer at least once.
    • BCC is the most common form of skin cancer; about one million of the cases diagnosed annually are basal cell carcinomas. BCCs are rarely fatal, but can be highly disfiguring.
    • SCC is the second most common form of skin cancer. More than 250,000 cases are diagnosed each year1, resulting in approximately 2,500 deaths.

Classic Risk Factors

  • Elderly caucasian
  • Light complexion/blue eyes
  • Actinic damage (sun damage)
  • Cigarette smoking

More than 90 % of Non-Melanoma Skin Cancer

is Caused by Sun Exposure

  • Unprotected exposure
  • Outdoors even in the fog
  • Tanning booths
  • Through car, home or office windows
  • Yet only 33% of women and 10% of men wear daily sun block
  • Learn More: www.skincancer.org

Risk Factors Specific to Squamous Cell Carcinoma

  • HPV 16 and 18 (Human papilloma virus)
  • Immunosuppression (weakened immune system)
  • HIV – atypical, younger patients
  • Organ transplant
  • Xeroderma pigmentosum ( a genetic skin disorder)
  • Predisposition for epithelial tumors

Incidence Of Skin Cancers in the Young

Incidence:

  • Melanoma has tripled
  • Squamous cell carcinoma and basal cell carcinoma have doubled

1 in 5 Americans in their 20’s and 30’s will be diagnosed with skin cancer.
Men: are twice as likely as women to be diagnosed with skin cancer.

Skin Cancer Affects Non-Caucasians Too

Melanoma of the skin
Hispanic: birth to death risk
Male: .45 (1 in 221)
Female: .49 (1 in 205)

Graph Skin Cancer Affects Non-Caucasians Too

Skin Cancer Affects Non-Caucasians Too

Skin Cancer MORE deadly for African Americans, Asians & Latinos

Caucasians

1974-1976: 81 %
1995-2001: 92 %

African Americans

1974-1976: 67%
1995-2001: 76%

Melanoma Surveillance, Epidemiology and End Results Program, 1975-2002, National Cancer Institute 2005; American Cancer Society, Surveillance Research, 2006

Skin Cancer MORE deadly for African Americans, Asians & Latinos

U.S. Skin Cancer Statistics

  • Incidence of has tripled since 1980
  • Early detection is crucial

What to Look for

History: Have you had a prior skin cancer ?

  • If history of BCCA -> 50% have second lesion at 5 years
  • If history of SCCA -> 75% have second lesion at 5 years

Think beyond the face:

  • Women: lower legs
  • Men: back

Do you have:

  • Pain ? (Usually painless)
  • Intermittent scaling or scabbing?
  • Irritation when wearing glasses?

Patient Education Gallery

Basal Cell Carcinoma

Basal Cell Carcinoma

Infiltrative Basal Cell Carcinoma

Medial Canthal Basal Cell Carcinoma

Ulcerative Basal Cell Carcinoma

Umbilicated Basal Cell Carcinoma

Squamous Cell Carcinoma

Cystic Squamous Cell Carcinoma

Squamous Cell Carcinoma

Eyelid Melanoma

Melanoma

Sebaceous Cell Carcinoma

Sebaceous Cell Carcinoma

Sebaceous Cell Carcinoma

Unusual Lesions

Keratoacanthoma

Lentigo Maligna

Non-Cancerous

Capillary Hemangioma

Cavernous Hemangioma

Eccrine Cyst

Epithelial Inclusion Cyst

Trichofolliculoma

Apocrine Hidrocystomas

Compound Nevus

Intradermal Nevus

Verruca Vulgaris Papilloma

Papilloma

Seborrheic Keratosis

Orbital Cancer

    • Differential:
      • Orbital Cancer in Adults
        • Lymphoma
        • Sarcoma
        • Plasmacytoma
        • Lacrimal Gland Cancers
          • Transitioned Pleomorphic Adenoma
          • Adenoid Cystic Carcinoma
        • Metastatic disease
  • Orbital Cancer in Children
    • Rhabdomyosarcoma
    • Retinoblastoma
  • Multidisciplinary Cancers that Cause Visual Dysfunction
    • Sinus tumors
    • Brain tumors
    • Skin cancers