eMedicine Specialties > Dermatology > Malignant Neoplasms

Sebaceous Carcinoma: Differential Diagnoses & Workup

Author: James M Spencer, MD, Professor of Clinical Dermatology, Mount Sinai School of Medicine, New York; Private Practice, Spencer Dermatology, St Petersburg, Florida
Coauthor(s): Amy Lynn Basile, DO, MPH, Sun Coast Hospital/Largo Medical Center, Largo, Florida
Contributor Information and Disclosures

Updated: Feb 19, 2009

Differential Diagnoses

Basal Cell Carcinoma
Sarcoidosis
Cutaneous Horn
Squamous Cell Carcinoma
Merkel Cell Carcinoma
Metastatic Carcinoma of the Skin
Pyogenic Granuloma (Lobular Capillary Hemangioma)

Other Problems to Be Considered

Chalazion
Keratoconjunctivitis
Blepharoconjunctivitis
Conjunctival carcinoma in situ
Leukoplakia
Ocular pemphigoid
Granulomatous inflammation from syphilis or tuberculosis
Central retinal artery occlusion and proptosis
Lacrimal gland tumors
Exophthalmos
Benign adnexal tumors

Workup

Laboratory Studies

  • Baseline studies include liver function tests, electrolyte levels, and a complete blood cell count to rule out metastatic disease and to establish a baseline for future care. Normal results of these tests also help to rule out any tumors associated with Muir-Torre syndrome.
  • More detailed studies can be directed by these findings.

Imaging Studies

  • Chest radiography may be performed to rule out metastatic disease and to establish a baseline for future care.

Other Tests

  • A systemic evaluation includes a complete medical and family history and a physical examination, including a detailed ophthalmologic examination, palpation of the lymph nodes, a thorough skin examination, and a review of systems.
  • Evaluation for Muir-Torre syndrome includes a preliminary rectal examination, colonoscopy or barium enema, and a first-morning urine for cytologic analysis.
    • Colorectal carcinoma is the most common visceral malignancy in Muir-Torre syndrome.13 Most of these malignancies occur proximal to the splenic flexure, and, thus, digital examination and flexible sigmoidoscopy would be inadequate to aid in the diagnosis.
    • The urine cytologic analysis is used to screen for genitourinary malignancy.

Procedures

  • Successful diagnosis results from suspecting this rare tumor in the first place and performing an adequate biopsy.
  • A full-thickness eyelid biopsy is generally recommended in cases in which a papular or nodular primary tumor is evident.10,42
  • Some authors have recommended fine-needle aspiration for primary and metastatic sebaceous gland carcinoma,43,44 but a full-thickness surgical biopsy is mandatory if the results are negative or equivocal.
  • Approximately 50% of patients have clinically inapparent extension of tumor cells in the surrounding epidermis, termed pagetoid spread. This may extend considerable distances beyond the main body of the tumor. Conjunctival map biopsies are recommended to delineate the presence and extent of pagetoid spread.45
  • Parotidectomy has also been reported in cases of sebaceous carcinoma with regional lymphadenopathy or metastasis.9 Given the potential for metastasis to the parotid gland, further evaluation is warranted, particularly with an upper eyelid sebaceous carcinoma.6,27,33

Histologic Findings

Sebaceous gland carcinoma demonstrates disordered invasion of the dermis by lobules of poorly defined sebaceous cells or basaloid/squamoid cells.46 Sebocytes tend to have multivacuolated clear cytoplasm, causing the nucleus to be scalloped from the lipid invasion.14 In many cases, moderate-to-severe atypia can be found, as well as a high nuclear/cytoplasm ratio and a perinuclear halo, identified in all 30 cases presented by Izumi et al.14 In some cases, well-developed sebocytes can be identified; in a smaller number of cases, sebaceous duct differentiation can be seen.14 Sebaceous carcinoma can be stained positively with oil red-O or Sudan black, which are specific for cytoplasmic fat, but epithelial membrane antigen (EMA) immunoperoxidase staining may be a better supplemental stain for confirming sebaceous differentiation.47

Sebaceous gland carcinoma may also exhibit clinically inapparent extension beyond the obvious tumor within the adjacent epithelia. Cells seen in the adjacent epithelia, often appearing to be separate from the main tumor, are known as pagetoid spread. This typically occurs within the conjunctivae, but it can also occur in the adjacent skin or the cornea. This phenomenon is seen in approximately 40-80% of reported series.10 The significance of these intraepithelial cells is unclear, with some authors reporting a worse prognosis when present15 and others reporting no significant difference in outcome when present. Given the possibility that these cells represent tumor infiltration rather than premalignant or reactive cells, a conjunctival map biopsy to delineate the presence and the extent of pagetoid spread seems warranted.45

More on Sebaceous Carcinoma

Overview: Sebaceous Carcinoma
Differential Diagnoses & Workup: Sebaceous Carcinoma
Treatment & Medication: Sebaceous Carcinoma
Follow-up: Sebaceous Carcinoma
References
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Further Reading

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Keywords

sebaceous carcinoma, sebaceous gland carcinoma, meibomian gland carcinoma, sebaceous cell carcinoma

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Contributor Information and Disclosures

Author

James M Spencer, MD, Professor of Clinical Dermatology, Mount Sinai School of Medicine, New York; Private Practice, Spencer Dermatology, St Petersburg, Florida
James M Spencer, MD is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Dermatological Association, American Medical Association, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, and International Society for Dermatologic Surgery
Disclosure: Graceway Pharmaceutical Honoraria Speaking and teaching; Sanofi Aventis Honoraria Consulting; Medicis Grant/research funds Other

Coauthor(s)

Amy Lynn Basile, DO, MPH, Sun Coast Hospital/Largo Medical Center, Largo, Florida
Amy Lynn Basile, DO, MPH is a member of the following medical societies: American Medical Association, American Osteopathic Association, and American Osteopathic College of Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Kelly M Cordoro, MD, Fellow and Clinical Instructor, Department of Pediatric Dermatology, University of California at San Francisco; Assistant Professor (On Educational Leave), Assistant Program Director for Resident Medical Education, Department of Dermatology, University of Virginia School of Medicine
Kelly M Cordoro, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Association of Professors of Dermatology, Dermatology Foundation, Medical Society of Virginia, National Psoriasis Foundation, Society for Pediatric Dermatology, and Women's Dermatologic Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

John G Albertini, MD, Consulting Staff, Dermatologic Surgery, The Skin Surgery Center
John G Albertini, MD is a member of the following medical societies: American Academy of Dermatology and American College of Mohs Micrographic Surgery and Cutaneous Oncology
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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