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Sebaceous Gland Carcinoma Treatment & Management

  • Author: Michael L Glassman, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Mar 16, 2015
 

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.

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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.

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Complications

Orbital invasion and lymph node metastases have occurred.

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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.

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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, PhD, CM, FRCSC, FACS Assistant Professor of Ophthalmology, McGill University Faculty of Medicine; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD

Mounir Bashour, MD, PhD, CM, FRCSC, 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, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department 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, Association for Research in Vision and Ophthalmology, American Glaucoma Society

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, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Acknowledgements

Mirelle Benchimol, MD Consulting Staff, Benchimol Eye Clinic

Disclosure: Nothing to disclose.

References
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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.
 
 
 
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