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Sebaceous Gland Carcinoma

Author: Michael L Glassman, MD, Ophthalmic Plastic, Orbital and Reconstructive Surgery, Department of Ophthalmology, Oculoplastic and Orbital Surgery, New York Eye and Ear Infirmary, Manhattan Eye Ear and Throat Hospital
Coauthor(s): Mounir Bashour, MD, CM, FRCS(C), PhD, FACS, Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD; Mirelle Benchimol, MD, Consulting Staff, Benchimol Eye Clinic
Contributor Information and Disclosures

Updated: Dec 15, 2008

Introduction

Sebaceous glands are part of epidermal appendages. Neoplasms of the sebaceous glands may be benign, such as sebaceous hyperplasia or sebaceous gland adenomas. The malignant sebaceous gland carcinoma most commonly arises in the periocular area. Fewer than 120 cases of sebaceous cell carcinoma have been reported at extraocular sites. The most common site of origin is the meibomian glands of the eyelids, leading to the term meibomian gland carcinoma. However, this neoplasm can occur in other sebaceous glands, such as in the caruncle, the glands of Zeis, and in the eyebrow. Sebaceous cell carcinoma is a lethal eyelid malignancy and can masquerade as benign conditions. Error or delay in diagnosis is common, and this tumor carries a significant mortality rate with metastasis.

History of the Procedure

This type of tumor has been confused with other tumors, both clinically and histologically.

Frequency

The incidence of sebaceous cell carcinoma is 3.2% among malignant tumors and 0.8% of all eyelid tumors. The mortality rate is 22%.

Sebaceous cell carcinomas are typically found in women, more often in the seventh decade of life, and they usually are on the upper eyelid margin.

In a recent retrospective study, 31 patients were diagnosed with sebaceous cell carcinoma of the ocular adnexa on histopathology. Twenty (65%) of the patients were women and 11 were men. The upper eyelid was involved in 18 patients, the lower eyelid in 10, the upper and lower eyelids in 1, and the caruncle in 2.1

Although sebaceous cell carcinomas are more common in elderly patients, they may be seen in younger patients with a history of radiation to the face.

Etiology

Carcinoma of the meibomian and Zeis glands

Pathophysiology

Sebaceous cell carcinoma may mimic either chalazion or chronic blepharitis. It tends to invade locally, as well as spreading to regional lymph nodes. Sebaceous cell carcinomas may grow in nests with central necrosis. The intraepithelial spread may lead to the erroneous histologic diagnosis of epithelial dysplasia or carcinoma in situ.

Foamy cytoplasm is seen only in sebaceous carcinoma, but it is absent in conjunctival or cutaneous squamous cell carcinoma. It also can histologically mimic basal cell carcinoma, squamous carcinoma, or Merkel cell tumor.

Either fresh tissue or formalin-fixed tissue not exposed to alcohol can be frozen, and positive fat stains, such as oil red O, can confirm the diagnosis of sebaceous carcinoma.

Presentation

The clinical appearance of sebaceous gland carcinoma is highly variable. They simulate such benign conditions as chalazion, blepharoconjunctivitis, keratitis, and other malignant or benign skin lesions.

Many of the skin tumors have a predilection for the upper eyelid and have a yellowish appearance. Tumors at the eyelid margin commonly cause loss of eyelashes. Classically, this lesion is a firm, painless, indurated mass or ulceration associated with the loss of cilia, in an area that has been treated for recurrent chalazia.

Both the history and the presentation of sebaceous cell carcinoma are variable. Typically, there is an insidious onset of a painless firm eyelid mass. This mass easily can appear clinically as a recurrent or chronic chalazion. Sebaceous cell carcinoma also can mimic unilateral blepharoconjunctivitis, meibomitis, basal or squamous cell carcinoma, conjunctival or corneal carcinoma in situ, orbital inflammation, or superior limbic keratoconjunctivitis.

Indications

Perform a biopsy on all recurrent or resistant chalazia, as well as new nonresolving lesions of the eyelid.

Relevant Anatomy

Sebaceous tumors of the eyelid may arise from meibomian glands, Zeis glands, or glands associated with the caruncle.

The meibomian glands originate in the tarsus and number approximately 25 in the upper eyelid and 20 in the lower eyelid. They are oil-producing sebaceous glands. A chalazion is an inflammation caused by obstruction of the meibomian glands and occasionally can be confused with sebaceous cell carcinoma.

Zeis glands are small, modified, sebaceous glands that open into the hair follicles at the base of the eyelashes.

Contraindications

There are no contraindications. This tumor can masquerade as other tumors, both benign and malignant.

More on Sebaceous Gland Carcinoma

Overview: Sebaceous Gland Carcinoma
Workup: Sebaceous Gland Carcinoma
Treatment: Sebaceous Gland Carcinoma
Follow-up: Sebaceous Gland Carcinoma
Multimedia: Sebaceous Gland Carcinoma
References
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References

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  2. Awan KJ. Sebaceous carcinoma of the eyelid. Ann Ophthalmol. May 1977;9(5):608-10. [Medline].

  3. Brauninger GE, Hood CI, Worthen DM. Sebaceous carcinoma of lid margin masquerading as cutaneous horn. Arch Ophthalmol. Nov 1973;90(5):380-1. [Medline].

  4. Chao AN, Shields CL, Krema H, et al. Outcome of patients with periocular sebaceous gland carcinoma with and without conjunctival intraepithelial invasion. Ophthalmology. Oct 2001;108(10):1877-83. [Medline].

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

  6. Khan JA, Doane JF, Grove AS Jr. Sebaceous and meibomian carcinomas of the eyelid. Recognition, diagnosis, and management. Ophthal Plast Reconstr Surg. 1991;7(1):61-6. [Medline].

  7. Lai TF, Huilgol SC, Selva D, et al. Eyelid sebaceous carcinoma masquerading as in situ squamous cell carcinoma. Dermatol Surg. Feb 2004;30(2 Pt 1):222-5. [Medline].

  8. Margo CE, Lessner A, Stern GA. Intraepithelial sebaceous carcinoma of the conjunctiva and skin of the eyelid. Ophthalmology. Feb 1992;99(2):227-31. [Medline].

  9. Nijhawan N, Ross MI, Diba R, et al. Experience with sentinel lymph node biopsy for eyelid and conjunctival malignancies at a cancer center. Ophthal Plast Reconstr Surg. Jul 2004;20(4):291-5. [Medline].

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  11. von Below H, Rose GE, McCartney AC, et al. Multicentric sebaceous gland carcinoma of the lid?. Br J Ophthalmol. Dec 1993;77(12):819-20. [Medline].

  12. Wagoner MD, Beyer CK, Gonder JR, et al. Common presentations of sebaceous gland carcinoma of the eyelid. Ann Ophthalmol. Feb 1982;14(2):159-63. [Medline].

  13. Yeatts RP, Waller RR. Sebaceous carcinoma of the eyelid: pitfalls in diagnosis. Ophthal Plast Reconstr Surg. 1985;1(1):35-42. [Medline].

  14. Zurcher M, Hintschich CR, Garner A, et al. Sebaceous carcinoma of the eyelid: a clinicopathological study. Br J Ophthalmol. Sep 1998;82(9):1049-55. [Medline].

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Further Reading

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Keywords

sebaceous gland carcinoma, meibomian gland carcinoma, sebaceous carcinoma, sebaceous cell carcinoma, carcinoma of meibomian and Zeis glands, sebaceous hyperplasia, sebaceous gland adenomas, eyelid malignancy

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Contributor Information and Disclosures

Author

Michael L Glassman, MD, Ophthalmic Plastic, Orbital and Reconstructive Surgery, Department of Ophthalmology, Oculoplastic and Orbital Surgery, New York Eye and Ear Infirmary, Manhattan Eye Ear and Throat Hospital
Michael L Glassman, MD is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Coauthor(s)

Mounir Bashour, MD, CM, FRCS(C), PhD, FACS, Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD
Mounir Bashour, MD, CM, FRCS(C), PhD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American College of International Physicians, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, American Society of Mechanical Engineers, American Society of Ophthalmic Plastic and Reconstructive Surgery, Biomedical Engineering Society, Canadian Medical Association, Canadian Ophthalmological Society, Contact Lens Association of Ophthalmologists, International College of Surgeons US Section, Ontario Medical Association, Quebec Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Mirelle Benchimol, MD, Consulting Staff, Benchimol Eye Clinic
Disclosure: Nothing to disclose.

Medical Editor

Jorge G Camara, MD, Professor of Ophthalmology, Department of Surgery and Director of Fellowship Training Program in Ophthalmic Plastic and Reconstructive Surgery for Countries Served by the Aloha Medical Mission, University of Hawaii John A Burns School of Medicine
Jorge G Camara, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and American Society of Ophthalmic Plastic and Reconstructive Surgery
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Mark T Duffy, MD, PhD, Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic; Medical Director, Advanced Cosmetic Solutions, A BayCare Clinic
Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience
Disclosure: Allergan - Botox Cosmetic Consulting fee Consulting; Quest medical - lacrimal balloons Honoraria Speaking and teaching; Ortho-Neutrogenia Consulting fee Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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