Cases Of Sebaceous Gland Carcinoma Research Articles

Medicamentous Therapy of Malignant Eyelid Tumors

Although surgical therapy is often the first-line treatment for malignant eyelid tumors, pharmacological treatment approaches can also be included and pursued in the treatment plan. Narrative review with a selective literature search on PubMed and Google Scholar. Various pharmacological therapeutic principles are currently available. One option is the local application of agents within the tumor area. This can be achieved through cytostatically active drugs such as 5-fluorouracil for superficial basal cell carcinomas and precursors of squamous cell carcinomas, or through mitomycin C in specific cases of sebaceous gland carcinoma. Another form of pharmacological local therapy is local immunomodulation using Imiquimod for superficial basal cell carcinomas, actinic keratosis, and Bowen's disease. Furthermore, there are systemic pharmacological therapies like chemotherapies, for example in sebaceous cell carcinoma, or systemic immunomodulation using checkpoint inhibitors for example in basal cell carcinoma, squamous cell carcinoma, Merkel cell carcinoma, and melanoma. Additionally, targeted therapies offer yet another treatment modality that exploits the molecular biological characteristics of various tumor entities. Examples of this include Hedgehog inhibitors for basal cell carcinomas, EGFR inhibitors for squamous cell carcinomas, or BRAF inhibitors for melanomas. This review addresses these treatment options for malignant tumors of the eyelid and systematically organizes them for the reader. Even though the data on these eye tumors is still limited, the reported case studies using systemic therapies for malignant eyelid tumors demonstrate the potential of this treatment modality. However, the need for further research is high especially concerning the combination of different therapy principles for increasing the effectiveness of eyelid tumor therapy.

A clinical study on prevalence and management of eyelid tumours – A prospective observational study

To study the incidence of eyelid tumours pertaining to age, sex, lid, globe or orbital involvement and analyse the various aspects of treatment modalities and their functional and cosmetic outcome. A prospective study of 40 cases of eyelid tumours over a period of 1 year, both benign and malignant eyelid lesions were included and those with inflammatory lesions were excluded. Patients were evaluated and treated with appropriate modalities and the outcome was analysed. Malignant tumours were common in the age group between 60-85 years and benign tumours were common in the age group of 30-45 years. Benign tumours were more common among males and malignant tumours more common among females. Out of the 40 cases, 28 (70 %) eyelid lesions were benign and 12 (30%) cases were malignant. Benign tumours were found more commonly in the upper lid and malignant tumours in lower lid. Squamous papilloma was found to be the most common benign tumour, followed by pyogenic granuloma. Meibomian carcinomais the most common malignant tumour. Most common presentation of malignant eyelid tumour was ulcerative growth pattern. Meibomian carcinoma presented in the form of nodule and ulcerative growth pattern. The treatment for most of the benign tumour was simple excision and malignant tumour was wide local excision with 4-5 mm margin clearance. Glabellar rotation flap was performed in one case of meibomian carcinoma involving the medial aspect of lower lid after excision. Hughes tarso-conjunctival flap was performed in two cases of squamous cell carcinoma and basal cell carcinoma, after tumour excision as the defect involved more than 75% of the lower lid without involvement of canthus. Two cases one each of sebaceous carcinoma and squamous cell carcinoma involving the lateral aspect of lower lid was reconstructed after excision, with Tenzel flap. In one case of sebaceous gland carcinoma with diffuse involvement of the upper lid the was excised and reconstructed with Cutler-Beard technique.Histopathologic examination of all excised lesion must be done as an innocuous looking lesion might be malignant. Early clinical suspicion of malignancy and confirmation by incisional biopsy will aid in planning wide excision and appropriate method of lid reconstruction depending on the amount of lid loss. After wide excision of malignant tumour appropriate lid reconstruction technique is done as a primary procedure in all our patients and we could obtain good outcomes with no recurrences. Advanced tumours with orbital involvement and recurrent tumour need adjuvant chemotherapy or radiotherapy.

Commentary: Cryotherapy and the sebaceous glands.

Sebaceous glands are exocrine epithelial glands secreting protective surface lipids via a holocrine mechanism in which the sebocytes undergo a programmed disintegration. Sebaceous glands are found in the eyelids as the tarsal meibomian glands and the glands of Zeis near eyelash hair follicles.[1] Pathologically, the ophthalmic sebaceous gland lesions range from benign cysts and chalazia to malignant sebaceous gland carcinoma (SGC), which happens to be the most common eyelid malignancy in the Indian population.[2] Cryotherapy has been extensively used in ophthalmology, dermatology, and surgical specialties as a primary or adjunctive treatment for lesions ranging from intraocular tumors, eyelid cysts, skin tags, warts, and acne vulgaris to cervical and hepatic cancers.[3] There are two mechanisms of cryotherapy: (a) freezing-related direct cellular injury and (b) vascular disruption of the lesion. Its role in the treatment of localized basal cell carcinomas of the eyelid has been documented in the literature with a low recurrence rate.[2] The prolonged healing time with secondary intention healing and depigmentation remains a concern with cryotherapy of the skin tumors. However, it helps in preserving the functionality of essential structures like eyelids and the surrounding lacrimal system. The in vivo biological effect of cryotherapy on normal sebaceous glands has been evaluated with the help of coherent anti-Stokes Raman scattering microscopy by Jung et al.[4] They demonstrated that the effect of lipid crystallization had a limited role in causing cellular disruption. Instead, sebocyte loss occurred at temperatures lower than those required for lipid crystallization. In addition, the cryo-treated sebaceous glands began recovering 1–2 weeks after treatment. Ray Jalian et al.[5] also investigated the role of controlled local skin cooling in causing preferential injury to sebaceous glands to understand its mechanism in treating acne vulgaris. They observed that cooling-induced damage led to a 20% reduction in sebum output for 2 weeks, with minimal collateral injury to surrounding tissues. A higher number of freeze–thaw cycles and slower thawing resulted in more significant tissue injury. Immunohistochemistry-based expression of Ki67 (a proliferative marker) and keratin 15 (a progenitor basal cell marker) was not disrupted by cooling. This led them to conclude that cooling-induced damage was temporary and occurred due to disruption of cellular architecture, enzymatic activity, and decreased lipid content. The sebum output recovered after 4 weeks. Though both these studies used a temperature higher than what is used in ophthalmic practice, they did conclusively demonstrate the limited level of cytotoxicity as well as the temporary duration of the effect of cryotherapy on sebaceous glands. The ophthalmic literature describes the use of cryotherapy as an adjunct in addressing the pagetoid spread seen in eyelid SGC.[6] Lisman (1989) first reported the use of cryotherapy to manage the map biopsy-proven sites of pagetoid spread in six cases of sebaceous gland carcinoma, thereby avoiding exenteration.[7] Shields et al.[6] advocated the application of triple freeze cryotherapy on conjunctival edges to eliminate residual tumor cells. On the contrary, Esmaeli et al.[8] reported satisfactory outcomes in 50 patients of SGC without the need for cryotherapy. A survey of practice patterns in Nordic countries revealed that only 27% of respondents offered cryotherapy as an adjunctive treatment for addressing the pagetoid spread in SGC.[9] Thus, the biological effect of cryotherapy on sebaceous glands is limited and reversible. The reassurance provided by triple freeze and slow thaw to the margins may not be reliable in clinical practice. This fact has been highlighted by Alam et al.[10] in the present issue of this journal. They performed a histopathological study on a portion of excised SGC tumor that was subjected to cryotherapy. Greater than 50% of viable tumor cells along with extensive areas of necrosis were observed on microscopy, and the authors concluded that the cell damage induced by cryotherapy is insufficient for achieving adequate tumor control. We believe that an early diagnosis and timely treatment using a wide (~3-mm margin) full-thickness excision, intraoperative frozen section control, and map biopsy for pagetoid spread remains the preferred practice pattern. The adjunctive use of cryotherapy remains doubtful in the SGC of eyelids. Close monitoring and regular follow-up to observe for recurrences are vital in the long-term management of patients.

KARSINOMA KELENJAR SEBASEA DI PALPEBRA SUPERIOR MATA KIRI: LAPORAN KASUS

Abstrac: Sebaceous gland carcinoma is a rare and fast-growing, potentially lethal skin malignant tumor originating from the adnexal epithelium of the sebaceous glands. This carcinoma is more common in the superior palpebral than the inferior palpebral in a ratio of 3:1 and is more common in the elderly with a predilection for women. Because it is clinically similar to a chalazion or a chronic inflammatory condition that can cause delays in diagnosis. Because of this rarity, we report a case of sebaceous gland carcinoma of the superior palpebral left eye in a 67-year-old man. Keyword. Sebaseous gland carcinoma, superior palpebral, ocular sinistra

Peripunctal Mass Lesions: Clinicopathological Analysis and Surgical Outcomes-A Multicentric Series.

To report the epidemiology, histopathological spectrum, and surgical outcomes of peripunctal mass lesions. Multicentric retrospective case series involving 6 centers in India. All cases of peripunctal masses with histopathological diagnoses and minimum follow up of 3 months were included. Demographic data, clinical photographs, objective assessments of clinical improvement were assessed before and after treatment. A total of 50 patients were included. The mean age was 46.4 years (range: 12-76 years). The mean duration of complaints was 27.4 months (range: 1-120 months) and mean follow-up period after surgery was 15.8 months (range: 3-120 months). The most common presenting complaints were a mass lesion/cosmetic concern (82%), followed by epiphora (48%) and foreign body sensation (16%). The most common lesion was melanocytic nevus (19/50; 38%), followed by squamous papilloma (8/50; 16%), hidrocystoma (7/50; 14%), and epidermoid cyst (7/50; 14%). Three cases of malignant tumors were diagnosed: 2 cases of sebaceous gland carcinoma and 1 case of squamous cell carcinoma. In all, 21 of 50 (42%) cases underwent excision with the placement of a Mini-Monoka stent, whereas the remaining 29 cases underwent only excision. At final follow up, a healed punctal opening was visible in 46 of 50 (92%) of the cases; 2 (4%) cases had a slit-like punctum and in 1 case (2%), a stenosed punctum was visible. However, only 1 case (2%) reported epiphora at follow up. Peripunctal masses are largely benign and present most commonly on the lower eyelid. Melanocytic nevus is the most common peripunctal mass lesion. In the series, stent placement did not play a significant role in the functional outcome.

Prognostic significance of immune checkpoints in the tumour–stromal microenvironment of sebaceous gland carcinoma

BackgroundImmune checkpoint blockade strategies have gained attention in the treatment/prognosis of cancers by targeting the programmed death-1 (PD-1)/programmed death-ligand 1 (PD-L1) pathway alone or in combination with cytotoxic T-lymphocyte-associated antigen...

CDKN2A, CDK1, and CCNE1 overexpression in sebaceous gland carcinoma of eyelid.

To investigate the overexpression of genes in sebaceous gland carcinoma (SGC) of the eyelid compared to sebaceous adenoma of the eyelid in order to elucidate the molecular mechanism underlying pathogenesis. We performed histopathological examination of eyelid tissues surgically removed from four patients diagnosed with SGC (cases 1-3) and sebaceous adenoma (case 4) of the eyelid. Next, we performed global gene expression analysis of surgical tissue samples using a GeneChip® system and the Ingenuity Pathways Knowledge Base. The results of the GeneChip® analysis were explored with quantitative real-time polymerase chain reaction (qRT-PCR) analysis. In the SGC samples, we found that 211, 199, and 199 genes, respectively, showed ≥ 2.0-fold higher expression than those in the sebaceous adenoma sample (case 4); 194 genes were common to all three SGC samples. For the 194 genes with upregulated expression, functional category analysis showed that SGC of the eyelid employed a unique gene network, including cyclin-dependent kinase inhibitor 2A (CDKN2A), cyclin-dependent kinase 1 (CDK1), and cyclin E1 (CCNE1), which are related to cell cycle progression, incidence of tumor, and cell viability. Furthermore, qRT-PCR analysis showed that the expression levels of CDKN2A, CDK1, and CCNE1 were significantly upregulated in all SGC cases compared to those in the sebaceous adenoma case. These data were similar to the results of microarray analysis. Overexpression of cell cycle-related genes CDKN2A, CDK1, CCNE1, and their gene network may help elucidate the pathogenic pathway of SGC of the eyelid at the molecular level.

Human papillomavirus in ocular malignant tumours: a study from a tertiary eye care centre in North India

ObjectiveThe present study aims to detect the presence of human papillomavirus (HPV) in ocular malignant tumours, including retinoblastoma, eyelid squamous cell carcinoma (SCC), and sebaceous gland carcinoma (SGC), in the North Indian population. DesignProspective observational non randomized study. ParticipantsIn this study, 142 prospective cases of ocular malignant tumours (retinoblastoma, SGC, and SCC) were included. MethodsHPV was detected by multiplex PCR using PGMY09/11 primers in 142 patients with ocular malignancies. This was followed by genotyping using linear array (reverse hybridization). ResultsOf the 142 tumours studied, 72 were retinoblastoma, 30 SGC, and 40 SCC. The HPV genome was detected in 2.8% (4 of 142) of cases by multiplex PCR; all positive cases (4 of 40) were SCC. Genotyping revealed that all positives belonged to the high-risk HPV16 genotype. HPV-positive SCC patients had better disease-free survival. Retinoblastoma and SGC cases were negative for HPV. ConclusionsLow prevalence of HPV in ocular malignancies was observed in this study. The HPV genome was detected only in ocular squamous cell carcinoma cases and these patients were associated with better prognosis. HPV may not have a role in retinoblastoma and SGC in the North Indian population.

Evaluation of PD-L1 and PD-1 expression in aggressive eyelid sebaceous gland carcinoma and its clinical significance.

Purpose:Eyelid sebaceous gland carcinoma (SGC) is an aggressive but rare malignancy of ocular region. Over-expression of PD-L1 and PD-1 has been demonstrated in a variety of solid tumors including conjunctival melanoma. PD-L1 is an immunoinhibitory molecule that suppresses the effective T cells response against tumor antigen leading to the progression of tumors. Inhibitors of the interaction of PD-L1 and PD-1 are associated with good clinical response various carcinomas. The prognostic value of the PD-1/PD-L1 axis in SGC remains unexplored. The purpose of this study was to evaluate expressions of PD-1 and its ligand PD-L1 in SGC and correlate its expression with clinicopathological features and patients survival.Methods:The immunohistochemical expression of PD-L1 and PD-1 was evaluated in 30 SGC cases.Results:PD-L1 immunopositivity was detected in 41.9% of the SGC cases. PD-1 expression in tumor infiltrative lymphocytes (TILs) was observed in 53.3% samples. Tumor PD-L1 positivity, PD-1 expression in TILs and tumor size (>10 mm) was associated with reduced disease-free survival. On multivariate analysis only tumor size (>10 mm) and a combined positivity of PD-L1 in tumor cells and PD-1 in TILs with an odds ratio of 5.212 (95% confidence interval 1.449-18.737) continued to be significantly associated with SGC recurrence.Conclusion:PD-L1 is overexpressed in 50% of SGC cases. The combined tumor PD-L1 positivity and TILs showing PD-1 expression within the same SGC patient's samples predict high-risk SGC, suggesting that the up-regulation of PD-L1 in tumor cells and PD-1 positivity within the same SGC patient may aggravate tumor recurrence.

An Interesting Case of Sebaceous Gland Carcinoma of Upper Eyelid with Tubercular Lymphadenitis

An Interesting Case of Sebaceous Gland Carcinoma of Upper Eyelid with Tubercular Lymphadenitis

Immunohistochemical evaluation of stress-responsive protein sestrin2 and its correlation with p53 mutational status in eyelid sebaceous gland carcinoma

Backgroundp53 is a stress-activated tumour suppressor gene, and its mutation has been associated with solid tumours including non-melanoma skin cancers. Sestrin2 expression is associated with DNA damage and oxidative stress...

Eyelid sebaceous gland carcinoma: Varied presentations and reconstruction outcome.

PURPOSE:To analyze varying clinical presentations, histopathological features, and management outcome of sebaceous gland carcinoma (SGC) of the eyelid.MATERIALS AND METHODS:We retrospectively reviewed medical records of 30 patients with histologically proven cases of SGC of eyelid treated at tertiary care hospital.RESULTS:Patients were in the age group of 28–80 years, among which 18 (60%) were females and 12 (40%) were males. Mean follow-up period was 29.83 ± 8.14 months. Six out of 30 cases were lost to follow-up; hence, only 24 cases were analyzed for reconstruction techniques and management outcome. Initial anatomic sites involved were upper eyelid (10 cases [33.33%]), lower eyelid (5 cases [16.66%]), both upper and lower eyelid (10 cases [33.33%]), and medial canthus (1 case [3.33%]). Orbital extension at presentation was present in 4 cases (13.33%) while metastasis to preauricular lymph nodes was seen in 1 case (3.33%). T2 was the most common category according to TNM staging (14, 58.33%). Reconstruction techniques included direct closure with or without cantholysis in 5 (20.83%), closure with Tenzel's semicircular flap in 2 (8.33%), Cutler Beard repair in 5 (20.83%), and Hughes's flap with either cheek advancement flap or full-thickness skin graft in 3 (12.5%). Both upper eyelid and lower eyelid repair were done in three (12.5%) cases and medial canthal repair in one (4.16%) case. Five (20.83%) cases underwent exenteration. On histopathological examination, 23 (95.83%) patients had localized tumors while only 1 (4.16%) patient had pagetoid invasion. Recurrence was observed in three (12.5%) cases. One (4.16%) case died subsequent to brain metastasis.CONCLUSION:SGC of eyelid may have varied presentations, but early diagnosis and consequent surgical therapy has good outcome and higher survival rate.

An Unusual Case of Sebaceous Gland Carcinoma of the Upper Eyelid - A Case Report

Sebaceous gland carcinoma of the eyelid is an aggressive malignant tumor derived from adnexal epithelium of sebaceous glands. Sebaceous gland carcinoma took the second place of all malignant eyelid tumors and occurred in 19.1%. The upper lid involved by sebaceous gland carcinoma is 54.6% and has a predilection 3 times more than the lower lid. It presents as a poorly differentiated lesion[1], which suggests a possibility of misdiagnosis because of it similarities to basal or squamous cell carcinoma. A 55-year-old male presented with a left upper eyelid swelling with an ulcerated wound over the lateral 2/3rd of the upper eyelid. A differential diagnosis of sebaceous gland carcinoma, squamous cell carcinoma and basal cell carcinoma of the eyelid was made. The X-ray orbit showed that there is a homogenous soft tissue density lesion along the lateral aspect of orbit on left side and a bony irregularity seen along the lateral margin of orbit on left side. B-scan showed mixed echogenic lesions in the subcutaneous plane involving the upper eyelid. A wide excision with lower lid switch and cheek rotation flap was performed. The diagnosis of sebaceous gland carcinoma was confirmed on histopathological findings. An early diagnosis and appropriate treatment may decrease the long-term morbidity. It may also extend the survival rates of such patients.

MiRNA-200c and miRNA-141 as potential prognostic biomarkers and regulators of epithelial-mesenchymal transition in eyelid sebaceous gland carcinoma

BackgroundMicroRNA (miRNA)-200c and miRNA-141 are tumour suppressors, which regulate epithelial-mesenchymal transition (EMT), leading to tumour invasion and metastasis in various malignancies. miRNA-200c and miRNA-141 maintain the epithelial phenotype by post-transcriptionally...

Immunohistochemical expression of X-linked inhibitor of apoptosis in eyelid sebaceous gland carcinoma predicts a worse prognosis.

Purpose:Overexpression of the inhibitors of apoptosis proteins have been demonstrated in a variety and of solid tumors including melanomas and nonmelanomas skin cancers. X-linked inhibitor of apoptosis protein (XIAP) is an inhibitor of apoptosis which prevents apoptosis by inhibiting caspases 9, 7, and 3. The prognostic value of XIAP in sebaceous gland carcinoma (SGC) remains unexplored.Methods:The immunohistochemical expression of XIAP was evaluated in 29 SGC cases.Results:The cytoplasmic overexpression of XIAP was detected in 62% SGC cases. XIAP expression was found to be significantly associated with advanced age, large tumor size, and with reduced disease-free survival (P = 0.0174). XIAP expression and advance tumor Grade III emerged as significant risk factors on univariate analysis. On stepwise multivariate analysis, both increased cytoplasmic XIAP expression and high tumor grade were found to be significantly associated with recurrence. Patients with low XIAP immunoexpression had a longer disease-specific survival than those with high expression in the 5-year follow-up.Conclusion:The present study demonstrates at the immunohistochemical level that XIAP is overexpressed in SGC and that high expression could be of biological significance in the development of eyelid SGC. Our finding suggests that up-regulation of XIAP may aggravate tumor metastasis in SGC.

Clinical relevance of cyclooxygenase 2 and peroxisome proliferator-activated receptor γ in eyelid sebaceous gland carcinoma.

Sebaceous gland carcinoma (SGC) is a malignancy associated with the pilosebaceous unit, and occurs at ocular or non-ocular sites. Cyclooxygenases (COXs) are enzymes that are crucial for lipid metabolism. COX-2 is overexpressed in various cancers, and its inhibition by non-steroidal anti-inflammatory drugs is known to reduce the risk of many cancers. Peroxisome proliferator-activated receptor (PPAR)-γ is a transcription factor involved in adipogenesis. PPAR-γ is a potential therapeutic target for the treatment of malignant tumours, including colon carcinoma. The aim of this study was to explore the status of COX-2 and PPAR-γ as prognostic markers in human eyelid SGC. The immunohistochemical expression of COX-2 and PPAR-γ was evaluated in 31 SGC cases. Cytoplasmic expression of COX-2 was detected in 80% of the SGC cases, and nuclear expression of PPAR-γ in 87%. There were significant correlations of PPAR-γ expression with well-differentiated SGC [19/21 (90%)] and of COX-2 overexpression with reduced disease-free survival (P = 0.0441, log rank analysis). COX-2 expression [odds ratio (OR) 3.82, 95% confidence interval (CI) 1.02-14.33, P = 0.046] and lymph node metastasis (OR 0.17, 95% CI 0.04-0.65, P = 0.009) emerged as significant risk factors in the univariate analysis. However, COX-2 expression did not emerge as a significant independent prognostic factor in multivariate analysis. COX-2 is a potential marker for identifying high-risk SGC patients. Expression of PPAR-γ in eyelid SGC cases reflects terminal sebaceous differentiation. Inhibitors of COX-2 signalling and PPAR-γ agonists are both prospective novel therapeutic targets in the management of eyelid SGC patients.

ZEB2/SIP1 as novel prognostic indicator in eyelid sebaceous gland carcinoma.

Epithelial-mesenchymal transition (EMT) plays a pivotal role in tumor invasion and metastasis in various malignancies. ZEB2/SIP1 is an important EMT regulator and down-regulates E-cadherin expression. The present study was planned to explore status of EMT-associated markers ZEB2/SIP1 and E-cadherin in eyelid sebaceous gland carcinoma (SGC) and to correlate with clinicopathological high-risk features. Expressions of ZEB2 and E-cadherin were evaluated by immunohistochemistry in 65 cases of histopathologically proven eyelid SGC. The results were correlated with clinicopathological high-risk features and survival of the patients to determine the prognostic significance of ZEB2, E-cadherin, and various high-risk features. Cytoplasmic overexpression of ZEB2 and membranous loss of E-cadherin were seen in 68% and 66% of cases of eyelid SGC, respectively. ZEB2 overexpression was significantly associated with E-cadherin loss (P = .002). Overexpression of ZEB2 also showed significant association with lymph node metastasis (P = .046), orbital invasion (P = .049), large tumor size (P = .018), and advanced tumor stages (P = .036). Survival analysis revealed that patients with ZEB2 overexpression had poor survival. ZEB2 overexpression and orbital invasion were found to be independent prognostic indicators (univariate analysis). However, multivariate analysis showed that ZEB2 (hazard ratio, 0.094; 95% confidence interval, 00.012-0.709; P = .022) was the best poor prognostic indicator of eyelid SGC. Our study demonstrates the role of both ZEB2 and E-cadherin in the promotion of EMT in eyelid SGC. The outcome of this study also points toward ZEB2 as an independent prognostic marker as well as a potential therapeutic target in eyelid SGC.

Basal and lateral block resection for residual eyelid tumor during second stage reconstruction at 3 weeks

There are different techniques for reconstructing the eyelids and canthal area which may need modifications in some situations for proper reconstruction. Three cases of sebaceous gland carcinoma of the lids were done by different techniques, where the extent of the disease required subtotal lid excision. At 3 weeks when healing was noted and the histopathology reports were available, the second stage reconstruction was done along with tissue block excision. The block was excised from the site of graft-host junction showing margin involvement on histopathology. In the first case, the base of the excised margin showed infiltration following tumor excision, and hence a basal block of tissue was excised during second stage surgery. In the second case, the excised margin showed tumor involvement, so a lateral block of tissue was excised in second stage surgery. In the third case the deep basal block of tissue was excised during first stage only. In all the three cases, the excised block was free from tumor, but patient were kept on close follow-up. The technique has worked well in all the cases as no recurrence has occurred in 1-year follow-up. None of these patients received any radiotherapy or chemotherapy postoperatively. The postoperative appearances were normal with adequate functioning lids and earlier rehabilitation.

A Case of Giant Advanced Sebaceous Gland Carcinoma

Sebaceous carcinoma is a highly aggressive, potentially lethal tumour arising from the sebaceous glands in the skin. It accounts for 3.2% of all malignant skin tumours. An advanced case of sebaceous carcinoma with distant metastasis is very rare as most of them present in the periocular area and are easily visible. We present an elderly woman who presented with two large fungating exophytic masses over the right parotid/orbital region and right side of neck. FNAC showed cytological features suggestive of poorly differentiated carcinoma which on histopathological exam confirmed it to be sebaceous carcinoma. Unfortunately the patient succumbed to cardiac arrest before initiation of treatment. This is the largest case of sebaceous gland carcinoma of eyelid reported in the medical literature, confirming the local aggressive behavior of the tumor and highlighting the importance of early diagnosis.

Epigenetic inactivation of the E-cadherin gene in eyelid sebaceous gland carcinoma

E-cadherin and β-catenin are crucial components of the cell-cell adhesion complex. Their loss has often been associated with tumour metastasis and poor clinical outcome. Both loss of E-cadherin at the cell membrane and a stabilizing mutation in CTNNB1 (β-catenin gene) have been associated with ovarian, colorectal, hepatocellular and nonmelanoma skin cancer, such as squamous and basal cell carcinomas. Absence of E-cadherin may be caused by promoter hypermethylation of the E-cadherin gene (CDH1). To determine the role of E-cadherin promoter hypermethylation and CTNNB1 gene mutation in the aggressive behaviour of sebaceous gland carcinoma of the eyelid. Thirty-six cases of sebaceous gland carcinoma were subjected to E-cadherin methylation-specific polymerase chain reaction and mutational analysis for the CTNNB1 gene. E-cadherin and β-catenin staining was evaluated by immunohistochemistry. Results were correlated with the clinicopathological features of sebaceous gland carcinoma. nMethylation of the E-cadherin promoter region was detected in 72% of eyelid sebaceous gland carcinoma cases and loss of E-cadherin immunostaining in 83%. E-cadherin promoter hypermethylation showed a significant association with the loss of membranous E-cadherin (P = 0·038) and it was of borderline significance with reduced disease-free survival (P = 0·05). It was also found to be associated with advanced age (73%), tumour size ≥ 2 cm (77%), orbital invasion (83%), lymph node metastasis (60%), tumour recurrence (60%) and poor histological differentiation (90%). DNA sequencing revealed no stabilizing β-catenin gene mutation in sebaceous gland carcinoma. Loss of membranous β-catenin was observed in 61% cases, which associated significantly with both E-cadherin promoter methylation (P = 0·0262) and loss of E-cadherin membranous localization (P=0·0015). Epigenetic inactivation of the E-cadherin gene causes loss of membrane-bound E-cadherin and could contribute to the reduced disease-free survival in eyelid sebaceous gland carcinoma. Mutations in the β-catenin gene do not seem to be involved in the pathogenesis of eyelid sebaceous gland carcinoma.