eMedicine Specialties > Dermatology > Malignant Neoplasms

Sebaceous Carcinoma: Treatment & Medication

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

Treatment

Medical Care

Sebaceous gland carcinoma is an aggressive tumor with a tendency for both local recurrence and metastasis. Delay in diagnosis may contribute to the poor outcome in this tumor; therefore, a high degree of suspicion when eyelid lesions occur and a willingness to perform a biopsy will most likely contribute to a better prognosis for patients with this tumor. Radiation therapy has traditionally been considered palliative but not curative.

  • In a small series of 6 patients, all 6 experienced a relapse 2 months to 2 years following radiation therapy, but they remained tumor-free following subsequent surgery.48
  • Rao et al reported a mortality rate of 78% in patients treated primarily with radiation therapy, in contrast to a rate of 7% for those treated with wide excision15 ; however, one case report describes 2 patients who refused surgery who were successfully treated with radiation therapy49 and another case series describes 2 patients who underwent radiation therapy as well, with no recurrence after 27 and 36 months, respectively.27
  • Drawing conclusions from only a few cases is premature, but the possibility exists that advancements in radiation technology and technique may make this a viable therapeutic option in the future.
  • While the significance of pagetoid spread is debated, most authors agree treatment of this epithelioid spread is warranted. It has been suggested, but not studied, that topical chemotherapy to the involved conjunctivae following surgical excision of the invasive tumor may be beneficial.27,29

Surgical Care

Sebaceous gland carcinoma remains a dangerous tumor and produces significant morbidity and mortality. Heightened awareness by the clinician and early biopsy may impact management of this rare tumor. Therapeutically, cryosurgery and surgical excision have been used for sebaceous carcinoma.29

  • Cryosurgery has been useful for a variety of cutaneous tumors and holds the theoretic advantage of treating large areas of conjunctivae if pagetoid spread is present. Long-term studies evaluating the use of cryosurgery for sebaceous gland carcinoma with pagetoid spread need to be performed.
  • Surgery has been and remains the primary treatment modality for sebaceous gland carcinoma. When orbital involvement is documented, therapy has traditionally been orbital exenteration.42 Without orbital involvement, surgical therapy typically involves excision of the visible tumor plus 5-6 mm of healthy-appearing tissue in all directions, followed by either frozen section or permanent section for histologic analysis.50 This approach has not been completely satisfying, because local recurrence occurs in approximately one third of patients.
  • The use of the fresh tissue Mohs technique has been successful in a number of case reports; however, many of these reports are limited to 1-3 cases each for a total of approximately 75 cases in the literature, and the findings cannot be considered definitive. Nonetheless, a retrospective review of 49 cases of sebaceous carcinoma reveals a local recurrence rate of 12% (6/49) and a metastatic rate of 8%.51
  • This author has treated 18 patients with periocular sebaceous gland carcinoma using the fresh tissue Mohs technique, with an average follow-up period of 37 months. Two of these 18 patients had lesions recur, for a recurrence rate of 11.1%, and one of these patients also developed metastatic disease to the parotid lymph nodes, for a metastatic rate of 5.6%.50 This is a significant improvement over the local recurrence rate of 32% reported following conventional surgery.5 Given our current understanding of the treatment of sebaceous gland carcinoma, excision using the Mohs technique may become the treatment of choice.
  • The treatment of tumors with pagetoid spread remains controversial. Some authorities have suggested that complete excision of involved epithelia is necessary, while others have suggested only frank invasive tumor needs to be treated, after which only careful clinical observation of the involved epithelia is warranted. Given the aggressive nature of this tumor, treating pagetoid spread as direct tumor extension and continuing surgical excision until all margins are clear, including clear of pagetoid spread, is wise.52 In this author's series of 18 patients, 9 had pagetoid spread, and surgery was continued until the conjunctivae was clear because pagetoid spread can be seen on frozen sections.50 Future larger series are needed to better delineate the true significance of pagetoid spread.

Consultations

Referral to an internist and gastroenterologist is warranted in patients diagnosed with sebaceous carcinoma in order to evaluate for the presence of internal (internist) and bowel (gastroenterologist) lesions associated with Muir-Torre syndrome.

More on Sebaceous Carcinoma

Overview: Sebaceous Carcinoma
Differential Diagnoses & Workup: Sebaceous Carcinoma
Treatment & Medication: Sebaceous Carcinoma
Follow-up: Sebaceous Carcinoma
References
[ CLOSE WINDOW ]

References

  1. Kass LG, Hornblass A. Sebaceous carcinoma of the ocular adnexa. Surv Ophthalmol. May-Jun 1989;33(6):477-90. [Medline].

  2. Gomes CC, Lacerda JC, Pimenta FJ, do Carmo MA, Gomez RS. Intraoral sebaceous carcinoma. Eur Arch Otorhinolaryngol. Jul 2007;264(7):829-32. [Medline].

  3. Jacobs DM, Sandles LG, Leboit PE. Sebaceous carcinoma arising from Bowen's disease of the vulva. Arch Dermatol. Oct 1986;122(10):1191-3. [Medline].

  4. Tan O, Ergen D, Arslan R. Sebaceous carcinoma on the scalp. Dermatol Surg. Oct 2006;32(10):1290-3. [Medline].

  5. Nelson BR, Hamlet KR, Gillard M, Railan D, Johnson TM. Sebaceous carcinoma. J Am Acad Dermatol. Jul 1995;33(1):1-15; quiz 16-8. [Medline].

  6. Shields JA, Demirci H, Marr BP, Eagle RC Jr, Shields CL. Sebaceous carcinoma of the ocular region: a review. Surv Ophthalmol. Mar-Apr 2005;50(2):103-22. [Medline].

  7. Doxanas MT, Green WR. Sebaceous gland carcinoma. Review of 40 cases. Arch Ophthalmol. Feb 1984;102(2):245-9. [Medline].

  8. Khan JA, Grove AS Jr, Joseph MP, Goodman M. Sebaceous carcinoma. Diuretic use, lacrimal system spread, and surgical margins. Ophthal Plast Reconstr Surg. 1989;5(4):227-34. [Medline].

  9. Song A, Carter KD, Syed NA, Song J, Nerad JA. Sebaceous cell carcinoma of the ocular adnexa: clinical presentations, histopathology, and outcomes. Ophthal Plast Reconstr Surg. May-Jun 2008;24(3):194-200. [Medline].

  10. Wolfe JT 3rd, Yeatts RP, Wick MR, Campbell RJ, Waller RR. Sebaceous carcinoma of the eyelid. Errors in clinical and pathologic diagnosis. Am J Surg Pathol. Aug 1984;8(8):597-606. [Medline].

  11. Pang P, Rodriguez-Sains RS. Ophthalmologic oncology: sebaceous carcinomas of the eyelids. J Dermatol Surg Oncol. Mar 1985;11(3):260-4. [Medline].

  12. Schwartz RA, Torre DP. The Muir-Torre syndrome: a 25-year retrospect. J Am Acad Dermatol. Jul 1995;33(1):90-104. [Medline].

  13. Schwartz RA, Torre DP. The Muir-Torre syndrome: a 25-year retrospect. J Am Acad Dermatol. Jul 1995;33(1):90-104. [Medline].

  14. Pang P, Rodriguez-Sains RS. Ophthalmologic oncology: sebaceous carcinomas of the eyelids. J Dermatol Surg Oncol. Mar 1985;11(3):260-4. [Medline].

  15. Rao NA, Hidayat AA, McLean IW, Zimmerman LE. Sebaceous carcinomas of the ocular adnexa: A clinicopathologic study of 104 cases, with five-year follow-up data. Hum Pathol. Feb 1982;13(2):113-22. [Medline].

  16. Beach A, Severance AO. Sebaceous gland Carcinoma. Ann Surg. Feb 1942;115(2):258-66. [Medline].

  17. Arshad AR, Azman WS, Kreetharan A. Solitary sebaceous nevus of Jadassohn complicated by squamous cell carcinoma and basal cell carcinoma. Head Neck. Apr 2008;30(4):544-8. [Medline].

  18. Duncan A, Wilson N, Leonard N. Squamous cell carcinoma developing in a naevus sebaceous of Jadassohn. Am J Dermatopathol. Jun 2008;30(3):269-70. [Medline].

  19. Kazakov DV, Calonje E, Zelger B, et al. Sebaceous carcinoma arising in nevus sebaceus of Jadassohn: a clinicopathological study of five cases. Am J Dermatopathol. Jun 2007;29(3):242-8. [Medline].

  20. Matsuda K, Doi T, Kosaka H, Tasaki N, Yoshioka H, Kakibuchi M. Sebaceous carcinoma arising in nevus sebaceus. J Dermatol. Aug 2005;32(8):641-4. [Medline].

  21. Miller CJ, Ioffreda MD, Billingsley EM. Sebaceous carcinoma, basal cell carcinoma, trichoadenoma, trichoblastoma, and syringocystadenoma papilliferum arising within a nevus sebaceus. Dermatol Surg. Dec 2004;30(12 Pt 2):1546-9. [Medline].

  22. Barkham MC, White N, Brundler MA, Richard B, Moss C. Should naevus sebaceus be excised prophylactically? A clinical audit. J Plast Reconstr Aesthet Surg. 2007;60(11):1269-70. [Medline].

  23. Kwitko ML, Boniuk M, Zimmerman LE. Eyelid tumors with reference to lesions confused with squamous cell carcinoma. I. Incidence and errors in diagnosis. Arch Ophthalmol. Jun 1963;69:693-7. [Medline].

  24. Ni C, Searl SS, Kuo PK, Chu FR, Chong CS, Albert DM. Sebaceous cell carcinomas of the ocular adnexa. Int Ophthalmol Clin. Spring 1982;22(1):23-61. [Medline].

  25. Berlin AL, Amin SP, Goldberg DJ. Extraocular sebaceous carcinoma treated with Mohs micrographic surgery: report of a case and review of literature. Dermatol Surg. Feb 2008;34(2):254-7. [Medline].

  26. Husain A, Blumenschein G, Esmaeli B. Treatment and outcomes for metastatic sebaceous cell carcinoma of the eyelid. Int J Dermatol. Mar 2008;47(3):276-9. [Medline].

  27. Callahan EF, Appert DL, Roenigk RK, Bartley GB. Sebaceous carcinoma of the eyelid: a review of 14 cases. Dermatol Surg. Aug 2004;30(8):1164-8. [Medline].

  28. Ni C, Guo BK. Pathologic classification of meibomian gland carcinomas of eyelids: clinical and pathologic study of 156 cases. Chin Med J (Engl). Oct 1979;92(10):671-6. [Medline].

  29. Shields JA, Demirci H, Marr BP, Eagle RC Jr, Stefanyszyn M, Shields CL. Conjunctival epithelial involvement by eyelid sebaceous carcinoma. The 2003 J. Howard Stokes lecture. Ophthal Plast Reconstr Surg. Mar 2005;21(2):92-6. [Medline].

  30. Justi RA. Sebaceous carcinoma; report of case developing in area of radiodermatitis. AMA Arch Derm. Feb 1958;77(2):195-200. [Medline].

  31. Hagedorn A. Adenocarcinoma of a meibomian gland. Arch Ophthalmol. 1934;6:850-67.

  32. Kitagawa H, Mizuno M, Nakamura Y, Kurokawa I, Mizutani H. Cutaneous horn can be a clinical manifestation of underlying sebaceous carcinoma. Br J Dermatol. Jan 2007;156(1):180-2. [Medline].

  33. Wick MR, Goellner JR, Wolfe JT 3rd, Su WP. Adnexal carcinomas of the skin. II. Extraocular sebaceous carcinomas. Cancer. Sep 1 1985;56(5):1163-72. [Medline].

  34. Altemani A, Vargas PA, Cardinali I, et al. Sebaceous carcinoma of the parotid gland in children: an immunohistochemical and ploidy study. Int J Oral Maxillofac Surg. May 2008;37(5):433-40. [Medline].

  35. El Demellawy D, Escott N, Salama S, Alowami S. Sebaceoma of the external ear canal: an unusual location. Case report and review of the literature. J Cutan Pathol. Oct 2008;35(10):963-6. [Medline].

  36. Alzaraa A, Ghafoor I, Yates A, Dhebri A. Sebaceous carcinoma of the skin of the breast: a case report. J Med Case Reports. Aug 15 2008;2:276. [Medline].

  37. Cibull TL, Thomas AB, Badve S, Billings SD. Sebaceous carcinoma of the nipple. J Cutan Pathol. Jun 2008;35(6):608-10. [Medline].

  38. Schlernitzauer DA, Font RL. Sebaceous gland carcinoma of the eyelid. Arch Ophthalmol. Sep 1976;94(9):1523-5. [Medline].

  39. Lemos LB, Santa Cruz DJ, Baba N. Sebaceous carcinoma of the eyelid following radiation therapy. Am J Surg Pathol. Sep 1978;2(3):305-11. [Medline].

  40. Hayashi N, Furihata M, Ohtsuki Y, Ueno H. Search for accumulation of p53 protein and detection of human papillomavirus genomes in sebaceous gland carcinoma of the eyelid. Virchows Arch. 1994;424(5):503-9. [Medline].

  41. Gonzalez-Fernandez F, Kaltreider SA, Patnaik BD, et al. Sebaceous carcinoma. Tumor progression through mutational inactivation of p53. Ophthalmology. Mar 1998;105(3):497-506. [Medline].

  42. Harvey JT, Anderson RL. The management of meibomian gland carcinoma. Ophthalmic Surg. Jan 1982;13(1):56-61. [Medline].

  43. Hood IC, Qizilbash AH, Salama SS, Young JE, Archibald SD. Needle aspiration cytology of sebaceous carcinoma. Acta Cytol. May-Jun 1984;28(3):305-12. [Medline].

  44. Maheshwari R, Maheshwari S, Shekde S. Role of fine needle aspiration cytology in diagnosis of eyelid sebaceous carcinoma. Indian J Ophthalmol. May-Jun 2007;55(3):217-9. [Medline].

  45. Putterman AM. Conjunctival map biopsy to determine pagetoid spread. Am J Ophthalmol. Jul 15 1986;102(1):87-90. [Medline].

  46. Rapini RP. Sebaceous Neoplasms. In: Practical Dermatopathology. Elsevier Inc; 2005:283-4.

  47. Bolognia JL, Jorizzo JL, Rapini RP. Sebaceous Carcinoma. In: Callen JP, Horn TD, Mancini AJ, Salasche SJ, Schaffer JV, Schwarz T, Stingl G, Stone MS, eds. Dermatology. 2nd ed. Amsterdam: Elsevier; 2008:1703.

  48. Nunery WR, Welsh MG, McCord CD Jr. Recurrence of sebaceous carcinoma of the eyelid after radiation therapy. Am J Ophthalmol. Jul 1983;96(1):10-5. [Medline].

  49. Yen MT, Tse DT, Wu X, Wolfson AH. Radiation therapy for local control of eyelid sebaceous cell carcinoma: report of two cases and review of the literature. Ophthal Plast Reconstr Surg. May 2000;16(3):211-5. [Medline].

  50. Spencer JM, Nossa R, Tse DT, Sequeira M. Sebaceous carcinoma of the eyelid treated with Mohs micrographic surgery. J Am Acad Dermatol. Jun 2001;44(6):1004-9. [Medline].

  51. Snow SN, Larson PO, Lucarelli MJ, Lemke BN, Madjar DD. Sebaceous carcinoma of the eyelids treated by mohs micrographic surgery: report of nine cases with review of the literature. Dermatol Surg. Jul 2002;28(7):623-31. [Medline].

  52. Folberg R, Whitaker DC, Tse DT, Nerad JA. Recurrent and residual sebaceous carcinoma after Mohs' excision of the primary lesion. Am J Ophthalmol. Jun 15 1987;103(6):817-23. [Medline].

  53. Yoon JS, Kim SH, Lee CS, Lew H, Lee SY. Clinicopathological analysis of periocular sebaceous gland carcinoma. Ophthalmologica. 2007;221(5):331-9. [Medline].

  54. Saito A, Tsutsumida A, Furukawa H, Saito N, Yamamoto Y. Sebaceous carcinoma of the eyelids: a review of 21 cases. J Plast Reconstr Aesthet Surg. Nov 2008;61(11):1328-31. [Medline].

  55. Rao NA, McLean JW, Zimmerman LE. Sebaceous carcinoma of the eyelid and caruncle: correlation of clinicopathologic features and prognosis. In: Jakobiec FA, ed. Ocular and adnexal tumors. Indiana, Pa: Aesculapuis; 1978:461-76.

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

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

[ CLOSE WINDOW ]

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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.