Sebaceous Gland Carcinoma of eyelids & face
The Sebaceous gland carcinoma (Sebaceous cell cancer) carcinoma is quite an uncommon & vigorously malignant skin (cutaneous) tumor (cancer). This lesion is said to be originating from the sebaceous glands in the skin and hence it may arise anywhere in the skin where these glands are located. The periocular region (eyelids and region around the eye) is the most common site where this lesion can be found. There is high risk of metastasis involved & hence prognosis is said to be very poor in such cases. This type of malignancy is thought to be a lethal kind of tumor. Sebaceous Carcinoma of extraocular (outside of eye) origin in the head is considered less locally aggressive and rarely tends to develop metastases as compared to ocular Sebaceous Carcinoma. Approximately 25% of sebaceous carcinomas arise in extraocular sites, most commonly on the head and neck.
Sebaceous gland carcinoma mainly affects the following regions in the eye:
-meibomian glands of the upper & lower eyelids
Sebaceous carcinoma can resemble non-cancerous conditions such as chalazion (stye). A non-healing stye despite taking treatment should be examined under microscope with the help of biopsy, with the suspicion of a sebaceous cancer.
Female preponderance is found in this type of cancers. The most common age group affected is in the 7th decade of life. Generally, most common site of the lesion being upper eyelid margin.
Even though, sebaceous cell carcinomas are mostly seen in elderly individuals, people in the younger age group with history of radiation exposure to the face may also present with sebaceous cell cancer.
Causes & Risk factors:
Exact cause underlying the condition is not known.
History of exposure to radiation is considered to be a major risk factor in case of younger patients.
A genetic condition known as Muir Torré syndrome, where there is another primary cancer already existing elsewhere in the body, is a predisposing factor for the development of sebaceous gland carcinoma. Therefore, people diagnosed with sebaceous gland cancer are often examined for signs of cancer elsewhere. This is just a precautionary measure.
The physical appearance of sebaceous gland carcinoma is extremely different & never has a fixed pattern.
They resemble benign conditions such as blepharoconjunctivitis, chalazion (stye), keratitis and other malignant or benign skin lesions.
Many of the skin tumors have a predisposition for the upper eyelid and are yellowish in appearance. Tumors at the eyelid margin commonly lead to loss of eyelashes. Classically, this lesion is a painless, firm in consistency, indurated compact mass or ulceration associated with the loss of cilia (eyelashes), in a non-healing area despite of being treated for presence of recurrent styes.
Both the history and the presentation of sebaceous cell carcinoma are highly variable. Typically, there is an slow gradual onset of a painless firm eyelid mass. This mass easily can appear clinically as a chronic or recurrent stye.
Sebaceous gland carcinoma of eyelid classically presents yellowish in appearance in the form of a nodule. It’s an asymptomatic lesion associated with loss of eyelashes.
A conjunctivitis or stye that is not healing despite of 2-3 months of constant observation & treatment should be examined under microscope & skin biopsy should be performed. A scrape biopsy may be carried out initially. On histopathologic evaluation of fresh tissue, the diagnosis can be confirmed.
Once the diagnosis is been confirmed, a metastatic survey is necessitated. Sebaceous carcinoma can spread to adjacent lymph nodes (pre-auricular and cervical) and to the distant organs such as lungs, brain, liver and bone as well. The occurrence of metastasis depends upon the site & size of the primarily existing tumor. Local tumor leading to invasion of adjacent regional lymph nodes, orbit or sites where there is evident local spread are associated with poor prognosis & chances of survival are very less in such cases.
Treatment requires a COMPLETE resection or excision (eyelid excision biopsy) of the tumor. We use frozen section control (Mohs Surgery) to provide negative margins. Larger surgeries, cryodestruction and radiation may be required if resection is not possible. Upper & lower eyelid reconstruction surgery is often needed for large tumors. Flap surgery like the Cutler beard Flap procedure, Tenzel Flap, Hughes Flap & Mustarde’s Cheek rotation flap are used in reconstruction of large upper & lower eyelid defects, post cancer removal. Exenteration (complete removal of the orbital contents is sometimes required for extensive or recurrent disease).
Topical chemotherapy & Radiotherapy are also found to be useful in managing the cases of sebaceous cell carcinoma. For metastasis to distant organs, systemic chemotherapy medication needs to be given.
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