Sebaceous Gland Carcinoma Treatment & Management

  • Author: Michael L Glassman, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 27, 2012
 

Surgical Therapy

Treatment aims to remove the malignant lesion to prevent local or systemic spread.

The treatment of sebaceous gland carcinoma is adequate surgical excision, with wide surgical margins and fresh frozen section controls to delineate the tumor edges. Lymph node evaluation is necessary to evaluate metastasis.

If diffuse involvement of the upper and lower eyelids is present, exenteration is required. Obtain a biopsy specimen of the areas of reddening of the conjunctiva that are suggestive of sebaceous gland carcinoma at the time of surgery.

Next

Follow-up

Monitoring for additional malignancies or metastatic sites is warranted. A marked increase in head and neck basal cell lesions is found in patients with previous eyelid malignancies. As many as 40% of patients also may have had or may develop other visceral malignancies.

Previous
Next

Complications

Orbital invasion and lymph node metastases have occurred.

Previous
Next

Outcome and Prognosis

In a retrospective study of 31 patients, as mentioned in Frequency, 23 patients had in situ disease, pagetoid disease, or both. Eight patients reported symptoms for less than 6 months, and 22 patients had symptoms for less than or equal to 12 months before the diagnosis of sebaceous cell carcinoma was made. Local surgical excision of the tumor as initial treatment was performed in 25 patients. Exenteration was the initial surgery performed in 4 patients. Two patients died from metastatic sebaceous cell carcinoma, which is lower than previous reports and may be related to earlier detection or improved surgical excision techniques.[1]

With wide excision and no evidence of metastasis, surgery results in a cure for the malignancies. However, sebaceous lesions have a high incidence of recurrence and metastasis.

The Mohs chemosurgery method is commonly used in facial and periocular nonmelanocytic malignancies. This method allows the focal and complete removal of a tumor with histologically verified margins. However, in diffuse tumors with high recurrence rates, such as sclerosing sweat duct carcinoma, recurrence rates may be as high with the Mohs chemosurgery method as with the traditional methods. In histologically verified sebaceous gland carcinoma, wide complete (ie, full thickness) resection is necessary. Sending additional margins for permanent sections as well as frozen section margins may increase success. Since multiple widespread adnexal biopsies need to be performed, the Mohs chemosurgery method probably is not warranted in most situations of sebaceous cell carcinoma.

Previous
 
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.

Specialty Editor Board

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.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

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.

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 Honoraria Speaking and teaching

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.

References

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

  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].

  10. Shields JA, Shields CL. Sebaceous carcinoma of the glands of Zeis. Ophthal Plast Reconstr Surg. 1988;4(1):11-4. [Medline].

  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].

 
Previous
Next
 
A 63-year-old white man with lower eyelid sebaceous cell carcinoma and lash loss is shown.
Gross pathology slide of sebaceous cell carcinoma, from same man as seen in image above.
Microscopic pathology slide of sebaceous cell carcinoma, from same man as seen in images above.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
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.