The masquerade syndrome.

Malignant lesions of the lid and ocular adnexae may present with striking inflammatory signs and this has most often been described with meibomian gland carcinoma and given the name of the masquerade syndrome. This paper presents examples of lid malignancies which have not only masqueraded as predominantly inflammatory lesions but whose origin was further obscured by the nature of the spread of the tumour in lid and conjunctiva. Recognition of the true nature of the malignancy only follows biopsy of the centre of the lesion which is fully justified in an older patient presenting with unilateral chronic, unresponsive inflammation especially involving the canthus and bulbar conjunctiva as well as the lid. Histological confirmation of the nature of the peripheral spread of the tumour is also of importance since pagetoid spread has been shown to be associated with more aggressive neoplasia and increased mortality.