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Case #7 (03-16-2004)

Discussion in 'Ophthalmology: Eye Physicians & Surgeons' started by Andrew_Doan, Mar 16, 2004.

  1. Andrew_Doan

    Andrew_Doan Doc, Author, Entrepreneur
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    CC:. 78 y.o. man with c/o of enlarging LLL lesion.

    HPI:. 78 y.o. man complained of a painless, red lesion noticed on the left lower lid (LLL) about 4-6 months. He was not sure if the lesion has grown in size, but wanted an evaluation because the lesion has not resolved.

    PMH: HTN, mild CAD, and mild cataracts.

    Exam:
    Best corrected visual acuities: 20/25 OU.
    Pupils: equal, no RAPD.
    EOM: full OU
    VF: normal
    DFE: retina exam notable for normal macula, vessels, and periphery OU.
    SLE: notable for the lesion shown below. Mild cataracts OU.

    Photo of the LLL lesion
    [​IMG]

    SLE Photo of the LLL lesion (higher magnification)
    [​IMG]

    SLE Photo of the LLL lesion, lid margin & palpebral conjunctivae
    [​IMG]


    Feel free to discuss the following:

    What tests should you order (I'll post labs when asked for them)?

    What's the differential diagnosis?

    What's the diagnosis?

    What is the treatment of choice, surgically and/or medically?


    Diagnosis is posted on the Iowa site.
    http://webeye.ophth.uiowa.edu/eyeforum/case7.htm
     
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  3. Redhawk

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    Has he ever had a lesion like this before? If so, did it resolve spontaneously or was it removed?

    Does he have a hx of extensive sun exposure or skin CA?

    Diff dx
    1. Chalazion. It's a painless lid lesion.
    2. Basal cell CA. Painless, most commonly affects the lower lid.
    3. Sebaceous gland CA. Can present as a recurrent chalazion.

    I suppose you could remove the lesion and send it for path study if it's recurrent or if you suspect possible skin CA.
     
  4. Gottschalk

    Gottschalk Member
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    I would send this lesion to either Derm Path or Oculo Path after Mohs removal because one would worry most about the lesion being sebaceous gland CA. This highly invasive CA commonly gets mislabeled as basal cell.

    What does the path report say Dr. Doan?
     
  5. Andrew_Doan

    Andrew_Doan Doc, Author, Entrepreneur
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    Discussion on the Iowa Site will be available in a few days.
     
  6. Andrew_Doan

    Andrew_Doan Doc, Author, Entrepreneur
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