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.
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.
Complications
Orbital invasion and lymph node metastases have occurred.
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.
-
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.
