Mycotic lesions of the skin of the eyelids and eye area are most often observed in childhood, adolescence and young age, i.e. at the age when it is least likely to encounter cases of cancer of the eyelids, nevertheless, they can become a source of diagnostic errors. This is due to the fact that some fungal skin diseases, especially deep mycosis of the skin – actiomycosis and blastomycosis, as well as highlighted by Soviet dermatologists (S.L. Bogrov, O.P. Podvysotskaya, S.K. Rozental, N.A. Chernogubov and etc.) A special form of trichophytosis of adults is found, for example, in patients in that period of life when malignant lesions of the skin of the eyelids are most often observed.
The possibility of diagnostic errors in such cases is explained by the fact that the external signs of the manifestation of fungal skin diseases are in many respects very similar to those for eyelid cancer. The superficial forms of mycosis of smooth skin, occurring on the spine and mainly on the face, can also be observed on the eyelids. They have the appearance of rounded and oval solitary lesions, surrounded by a thin rim of an undermined epithelium, protruding somewhat above the surface of the skin, or by a sharply hyperemic peripheral roller.
On the surface of the roller , bubbles or crusts are often visible , and in the center of the focus some retraction is revealed, covered with a flaky epidermis. The deep form of mycoses also manifests itself in the form of solitary, correctly rounded or oval, mostly large foci, on the surface of which there are follicular pustules, very reminiscent of the brushes characteristic of cystic basalomas. Since they are accompanied by significant, and even sharp intradermal infiltration, they may well resemble skin cancer of the eyelid.
The long-described cases of favus, accompanied by an increase in dense cervical, occipital and behind-the-ear lymph nodes (L.K. Goretsky), only confirm the possibility of such diagnostic errors in the recognition of eyelid cancer.
For the recognition of fungal diseases of the eyelids and cancer of the protective apparatus of the eye, it is necessary to be guided by the following very important points. 1. Anamnestic data invariably indicate a longer existence of skin cancer until external manifestations of malignant growth appear in comparison with the short existence of fungal skin lesions.
It should be noted that chronic mycotic skin lesion in adults is rarely localized on the face, and if it is localized here, it has completely different clinical signs than skin cancer of the eyelids: mycosis is often accompanied by itching, erythematous spots characteristic of it can have a bluish tint; fungal lesions rise less above the surface of the skin than any exophytic growing tumor of the skin; they affect large areas of the skin much faster as a result of the fusion of numerous small foci and turn into a continuous scaly surface of the scalloped shape with a bluish tint; on the periphery of the affected area, pronounced inflammatory phenomena are observed, which very rarely accompany skin cancer of the eyelids.
2. Any superficial trichophytosis of smooth skin usually manifests itself in the form of erythematous spots of a round and less oval shape, having on the periphery only a more hyperemic shaft, on which, however, small vesicles or crusts are sometimes visible, which could lead to an erroneous thought about the presence of cystic basal cell carcinoma or folliculo -epitheliomas.
Meanwhile, skin cancer of the eyelids , as a rule, rises more above the surface of the skin with exophytic growth or is accompanied by ulceration with endophytic growth, has a clearly defined and dense roller along the periphery, and with a cystic form consists of separate small brushes, sometimes merging and covered with an ulceration with a crust .
3. In cases difficult for differentiation , it is necessary to resort to microscopic examination of scales or scrapings from foci of microsporia on smooth skin, to crops on appropriate media to obtain growth of a fungal culture, or to a biopsy of a suspected tumor of the skin of the eyelid.