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Old 12-04-2011
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Eye A nodule on the lower eyelid!

A 69-year-old Caucasian woman comes to the clinic for a routine physical examination. While introducing yourself and getting to know the patient, you notice that she has a nodular lesion on her lower eyelid. When this is pointed out to her, she admits that it has been there at least a month or two, but states that she is not very concerned about it, as it doesn’t hurt and is not affecting her vision. She is a little annoyed, however, that the lesion seems to be getting slowly larger. A close examination of the lid lesion reveals a 1-cm, firm, painless, pearly, indurated nodule on the lower lid margin, with loss of eyelashes directly above the lesion. The central indentation seems to be mildly crusted with some degree of ulceration. The rest of the eyelid seems normal, aside from some mild telangiectasias spreading outward from the lesion. The eye itself is uninvolved. Which of the following is the most appropriate management?

A. Biopsy and resection of nodule and frozen section examination of surgical margins
B. Hot compresses and topical antibiotic ointment applied to lesion three times daily
C. Incision and drainage of nodule, hot compresses, return to the clinic in 1 week
D. Intralesional injection of long-acting corticosteroid, followup in 1 month
E. No further intervention, provide reassurance that lesion is not dangerous
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Old 12-04-2011
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Biopsy and resection of nodule and frozen section examination of surgical margins = basal cell carcinoma

But I think now the best treatment should be Mohs surgery
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Old 12-04-2011
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biopsy n resection of nodule to rule out basal cell CA
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Old 12-04-2011
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Biopsy and resection of nodule and frozen section examination of surgical margins
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Old 12-04-2011
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A. Biopsy and resection of nodule and frozen section examination of surgical margins
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A. Biopsy and resection of nodule and frozen section examination of surgical margins
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Old 12-05-2011
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A. Biopsy and resection of nodule and frozen section examination of surgical margins
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Old 12-05-2011
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The correct answer is A. This patient has a basal cell carcinoma (BCC). Basal cell carcinoma is the most common form of skin cancer and also accounts for approximately 90% of all malignant tumors of the eyelid. When it involves the eyelid, it most commonly occurs on the lower lid margin. It often is described as pearly, with surrounding telangiectasia, and may have a central area of ulceration, giving it the description of a “rodent ulcer,” as if a rodent had gnawed away at the lesion. The treatment, particularly in a location like the eye, involves Moh’s microsurgery, with examination of the margins to make sure all of the tumor cells have been removed.
Hot compresses and topical antibiotics (choice B) can be used to treat a stye. This lesion is not painful or warm, however, and has more of an insidious onset and prolonged time course than a stye. Hot compresses and topical antibiotics will not help this malignant lesion.
For styes or chalazions that do not resolve, an ophthalmologist may perform an incision and drainage (choice C). This technique is not appropriate for solid tumors.
Intralesional injections of corticosteroids (choice D) are used for a variety of eyelid lesions, including persistent chalazions and keloid scars. This is not the treatment for basal cell carcinoma, however, which needs to be surgically removed.
The patient should be advised that the lesion, though curable, is dangerous, and that further intervention is necessary. To do otherwise (choice E) is medical malpractice
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Old 12-05-2011
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A nodule on the lower eyelid!-eyes.jpg
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