Sebaceous Carcinoma Of Eyelid Research Articles

Neoadjuvant Chemotherapy in Recurrent Sebaceous Carcinoma of Eyelid With Orbital Invasion and Regional Lymphadenopathy

A 35-year-old man presented with a recurrent temporal conjunctival mass (25 × 12 mm) involving about six-clock hours of the limbus in the left eye. The mass encroached onto the temporal half of cornea and showed surface keratin, large intrinsic and feeder vessels. It infiltrated the deep corneal stroma. There were no cells in the anterior chamber. Ultrasound biomicroscopy confirmed infiltration of deep corneal stroma without intraocular invasion. Surgery involved excision of the conjunctival component with 4-mm margin, lamellar sclerectomy and a penetrating sclerokeratoplasty with 3 mm of healthy corneal margin. Cryotherapy (double-freeze-thaw) was done to the conjunctival margins. Histopathology showed it to be invasive sebaceous cell carcinoma. A thin layer of deep corneal stroma and all conjunctival margins were uninvolved. At thirty-six weeks after treatment the left eye recorded a visual acuity of finger counting at 1 meter distance and no recurrence.

Scrape cytology in the early diagnosis of eyelid sebaceous carcinoma

The low incidence and the non-specific clinical symptoms led us to conclude that the diagnosis of a sebaceous carcinoma of the eyelid often occurs very late. Sebaceous carcinoma of the ocular adnexa is a malignant neoplasm which can exhibit aggressive local behavior, can have pagetoid spread and can metastasize to regional lymph nodes and distant organs. The neoplasm is known to masquerade as other benign and less malignant lesions, and has relatively high morbidity and mortality. Scrape cytology was done in a 70-year-old female with a tumor in left upper lid. Cytological smears were suggestive of sebaceous carcinoma. Subsequently, histopathology confirmed the diagnosis of sebaceous gland carcinoma. The article highlights the role of scrape cytology in early diagnosis and subsequent appropriate surgical management of eyelid sebaceous gland carcinoma, to prevent recurrence and metastasis.

Incidence of cutaneous sebaceous carcinoma and risk of associated neoplasms

Sebaceous tumors of the skin occurring in association with an internal malignancy characterize Muir-Torre syndrome (MTS), a variant of hereditary nonpolyposis colon cancer (Lynch syndrome). To the authors' knowledge, only limited information exists regarding incidence patterns of sebaceous carcinoma (SC), and no prior study has quantified risks of associated cancers. The authors calculated cutaneous SC incidence rates (IRs) and IR ratios in 9 US Surveillance, Epidemiology, and End Results program registries (1973-2003). Indirectly standardized incidence ratios and 95% confidence intervals (95% CIs) were calculated for subsequent cancers among 2-month survivors of SC and for subsequent SC after other primary cancers. Among 664 cases of cutaneous SC, nearly 90% were diagnosed among whites (IR, 0.11 per 100,000 person-years), with significantly lower IR noted among blacks (IR, 0.04). Whereas eyelid SC IRs demonstrated no sex differences and stabilized in recent years, IRs of noneyelid SC predominated in men and rose steadily over time. Survivors of SC had a 43% (95% CI, 15%-76%) increased risk of subsequent cancer, and risk of SC was elevated by 52% (95% CI, 24%-84%) among survivors of other cancers. Whether before or after SC, the significant excesses of other primary cancers were limited to noneyelid SC. Patterns suggestive of genetic predisposition included >20-fold risks for early-onset (diagnosed in patients aged <50 years) SC associated with colon, pancreatic, ovarian, or uterine corpus cancers, whereas late-onset SC (diagnosed in patients aged > or =50 years) predisposed to ureter cancer. This population-based study of cutaneous SC revealed an association with a spectrum of early-onset cancers consistent with MTS. Etiologic heterogeneity was suggested by differences between eyelid and noneyelid SC in incidence patterns and associated cancer risks.

Eyelid Sebaceous Gland Carcinoma in a Young Caucasian Man

Eyelid sebaceous gland carcinoma is rarely observed in young Caucasian men. A 28-year-old man was referred for a recurring chalazion of the eyelid that had been operated four times in the past two years. The chalazion-like lesion of the external third of the upper left eyelid was associated with a cystic lesion. Cytology of the fluid in the cyst and histology of the lesion were compatible with a sebaceous cell carcinoma. Magnetic resonance imaging revealed that the cystic lesion associated with the eyelid tumour was extending into the orbit. According to current clinical practice and experience, to increase the chance of survival of the patient, an orbital exenteration was conducted to remove the sebaceous cell carcinoma in total. Although rare, one should be aware that an eyelid sebaceous cell carcinoma can occur in a young Caucasian man and this diagnosis should be evoked in case of a recurrent chalazion.

Treatment and outcomes for metastatic sebaceous cell carcinoma of the eyelid

To report the management and outcomes in patients with metastatic eyelid sebaceous cell carcinoma. The clinical records of four patients with metastatic eyelid sebaceous cell carcinoma treated between January 1999 and August 2006 were reviewed. The study included four women with a mean age of 66 years. Metastatic sites included the lung in three patients, regional lymph nodes in two, liver in two, and bone in one. Time from diagnosis of eyelid carcinoma to metastasis ranged from 0 to 62 months. Treatment of regional nodal metastasis consisted of complete neck dissection followed by radiation therapy. One patient developed lung metastasis 5 years after the diagnosis of eyelid tumor; she was treated with systemic chemotherapy followed by subtotal lung resection. Systemic chemotherapy was considered for two additional patients: in one, chemotherapy was deferred due to poor performance status and ongoing medical problems; and another patient died before chemotherapy could be started. The patient with bony metastasis was treated with radiation therapy to the spine. Two patients died during the study period. The follow-up time from diagnosis of metastasis to last contact or death ranged from 1 month to 3 years (median of 21 months). Eyelid sebaceous cell carcinoma can result in systemic metastasis and death. Metastasis can be discovered as late as 5 years after treatment of the eyelid carcinoma, warranting continued surveillance. Treatment of metastatic disease may include a combination of chemotherapy, radiation, and surgical neck dissection.

Clinical Features and Management of Eyelid Sebaceous Gland Carcinoma

Purpose: To investigate the clinical features and treatment results in eyelid sebaceous gland carcinoma. Methods: A retrospective chart review was conducted on 28 adult patients that were histopathologically diagnosed with eyelid sebaceous gland carcinomas from April 1981 to March 2005 in Seoul National University Hospital. Results: Among the 28 cases of eyelid sebaceous gland carcinoma, 9 cases (32.1%) had evidences of local invasion or metastasis at the initial diagnosis. Surgical resection was performed in the 27 cases (96.4%), and conjunctival cryotherapy, surgeries, such as maxillectomy, parotidectomy, and neck dissection, or radiation therapy were combined in cases of local invasion or metastasis. In the 19 cases of the localized tumor group, there were 2 cases (10.5%) of recurrence after an average 30 months of follow-up. The locally invasive tumor group (2 cases) showed 1 case of recurrence after 12 months of follow-up. In the 7 cases of the distant metastasis tumor group, tumors in 3 cases (42.9%) could not be controlled, and 3 cases (75.0%) showed recurrence after an average 45 months of follow-up. Conclusions: Eyelid sebaceous gland carcinomas with local invasion or metastasis afford higher potential for treatment failure, so early diagnosis is crucial. Because recurrence is possible, even when the tumor is completely removed, the extent of the tumor should be examined thoroughly and microscopically.

Sentinel Lymph Node Biopsy for Sebaceous Cell Carcinoma and Melanoma of the Ocular Adnexa

To provide clinical details and long-term outcome data for a series of patients with eyelid or conjunctival melanoma or eyelid sebaceous cell carcinoma who underwent sentinel lymph node (SLN) biopsy. Retrospective interventional case series with review of clinical records and pathologic specimens. Tertiary comprehensive cancer center. Twenty-five consecutive patients treated at 1 institution for eyelid or conjunctival melanoma or eyelid sebaceous cell carcinoma from December 2000 to October 2004. Surgical removal of the eyelid or conjunctival tumor and SLN biopsy. Local treatment modalities; lymphatic basins in which SLNs were identified; status of SLNs; false-negative rate; and long-term patterns of local recurrence, regional and distant metastasis, and survival. Seven patients had conjunctival melanoma, 8 had eyelid-margin melanoma with a considerable palpebral conjunctival component, and 10 had eyelid sebaceous cell carcinoma. The SLNs were identified in all but 1 patient by using technetium Tc 99m sulfur colloid as a tracer. Intraoperatively, in 16 patients in whom blue dye was used in addition to technetium Tc 99m sulfur colloid during mapping, no SLN was blue. One patient with conjunctival melanoma and 1 patient with eyelid melanoma had a histologically positive SLN. Two patients with eyelid melanoma and 2 patients with eyelid sebaceous cell carcinoma had negative findings from SLN biopsy but developed recurrence in their regional lymph nodes during the follow-up period. Overall, during follow-up, 2 of 10 patients with sebaceous cell carcinoma (20%) and 5 of 15 patients with eyelid or conjunctival melanoma (33%) had regional lymph node metastasis. Four patients with melanoma who had regional metastasis also developed distant organ metastasis. Two patients with sebaceous cell carcinoma--1 with regional metastasis and 1 without--developed distant organ metastasis. The detection of histologically positive SLNs in this series of patients may justify further study of SLN biopsy for high-risk patients with ocular adnexal melanoma or eyelid sebaceous cell carcinoma. The false-negative rate is higher than that reported for SLN biopsy at most other anatomic sites. Patients with negative findings from SLN biopsy still require careful long-term follow-up because they may develop regional or distant metastasis.

Role of fine needle aspiration cytology in diagnosis of eyelid sebaceous carcinoma

Sebaceous carcinoma of the ocular adnexa is a malignant neoplasm which can exhibit aggressive local behavior and can metastasize to regional lymph nodes and distant organs. The neoplasm is known to masquerade as other benign and less malignant lesions, resulting in delay in diagnosis and relative high morbidity and mortality. Fine needle aspiration cytology (FNAC) of recurrent upper eyelid nodules treated elsewhere as chalazion was done. Cytological smears were suggestive of malignancy. Subsequently histopathology confirmed the diagnosis of sebaceous gland carcinoma. Eyelid reconstruction was done after histopathologically confirmed tumor-free margins. The article highlights the role of FNAC in early diagnosis and subsequent appropriate surgical management of eyelid sebaceous gland carcinoma to prevent recurrence and metastasis.

Eyelid Sebaceous Carcinoma Associated With Muir-Torre Syndrome in Two Cases

We report the rare but serious association between sebaceous carcinoma of eyelid and Muir-Torre syndrome in two cases, a 79-year-old woman and 54-year-old man. The presenting sign was a yellow-pink nodule with telangiectatic vessels on the left lower eyelid in one patient and a yellowish-red, pedunculated lesion with intrinsic vascularization on the right superior tarsal conjunctiva in the other. A history of multiple primary colon cancers was present in both patients, associated transitional cell carcinoma of bladder and renal cancer in one patient and prostate cancer in the other. Both patients underwent excisional biopsy and cryotherapy of the eyelid tumors. Histopathology revealed sebaceous carcinoma of eyelid and conjunctiva. Immunohistochemical staining for MSH2 DNA mismatch repair gene performed in one patient showed lack of expression. Muir-Torre syndrome was diagnosed on the basis of sebaceous carcinoma, associated with multiple visceral malignancies in both patients. We conclude that patients with sebaceous carcinoma should have evaluation for visceral malignancies, mainly colon cancer.

Conjunctival Epithelial Involvement by Eyelid Sebaceous Carcinoma. The 2003 J. Howard Stokes Lecture

To determine incidence and distribution of conjunctival epithelial involvement by eyelid sebaceous carcinoma and to make recommendations regarding its management. The medical records were reviewed retrospectively on patients with histopathologically confirmed sebaceous carcinoma of the eyelids managed at the Oncology Service at Wills Eye Hospital. Those tumors with involvement of the conjunctival epithelium were identified and selected for further study. The incidence and distribution of epithelial involvement was determined, based on histopathology of resected tumors and map biopsies. The incidence of metastasis and tumor-related mortality was determined. Based on these findings and personal surgical experience, recommendations are made regarding management of eyelid sebaceous carcinoma with involvement of the conjunctival epithelium. Of 60 patients with sebaceous carcinoma, epithelial involvement of the conjunctiva was identified in 28 (47%). Of the 28 cases, the neoplasm affected the following sites: superior tarsal and fornical conjunctiva in 28 (100%), inferior tarsal conjunctiva in 19 (68%), inferior fornical conjunctiva in 18 (64%), superior bulbar conjunctiva in 19 (68%), and inferior bulbar conjunctiva in 16 (57%). The caruncle was involved in 15 (54%) and the cornea in 11 (39%). Metastasis occurred in 3 of the 28 cases (11%). Map biopsies, combined with cryotherapy, topical chemotherapy, local surgical resection, and orbital exenteration, were used to achieve local control. Eyelid sebaceous carcinoma was found to exhibit epithelial involvement of the conjunctiva in 47% of cases, predominantly in the superior tarsal and fornical conjunctiva and less often in the inferior tarsal conjunctiva, caruncle, and cornea. Treatment of this condition is challenging, and map biopsy, cryotherapy, topical chemotherapy, and newer surgical methods are being used more often by our group.

Sebaceous Carcinoma of the Eyelid: Analogy to Extramammary Paget’s Disease

We present a 69‐year‐old woman with a sebaceous carcinoma of the left upper eyelid, which originated from the Meibomian gland of the tarsal plate. The intraepidermal extension involved not only the conjunctival epithelium but also the overlying skin with subsequent extension into the dermis. The discussion will include diagnostic, both clinical and microscopic, considerations along with comparison to mammary Paget’s disease. Just as mammary Paget’s disease, which originates from the glands in the dermis eventuating in the seeding of the overlying epidermis, so too does sebaceous carcinoma of the eyelid. Accordingly, just as mammary Paget’s disease is often misdiagnosed as an inflammatory condition, so too is sebaceous carcinoma.

Experience with sentinel lymph node biopsy for eyelid and conjunctival malignancies

7549 Background: To describe our experience with sentinel lymph node (SLN) biopsy in patients with eyelid and conjunctival melanoma, Merkel cell carcinoma of eyelid, and sebaceous cell carcinoma of the eyelid. Methods: 20 patients with eyelid or conjunctival malignancies mentioned above were treated at The University of Texas M. D. Anderson Cancer Center between May 2002 and July 2003, had clinically and radiographically negative regional lymph nodes, and underwent preoperative lymphoscintigraphy using an injection of technetium Tc-99m (0.3 mCi) in 0.2 mL volume. Intraoperative mapping was performed with the same volume of technetium Tc-99m along with an injection of isosulfan blue dye. Results: 6 patients had conjunctival melanoma, 6 had eyelid sebaceous cell carcinoma, 6 had eyelid melanoma, and 2 had eyelid Merkel cell carcinoma. SLN(s) were identified in all patients. Intraoperatively, no SLN(s) were blue. 1 patient with conjunctival melanoma and 1 patient with Merkel cell carcinoma had a histological...

Fine needle aspiration cytology of eyelid sebaceous gland carcinoma and its differential diagnosis

To investigate the fine needle aspiration cytology (FNAC) features and differential diagnosis of eyelid sebaceous gland carcinoma. Four cases of eyelid sebaceous gland carcinoma diagnosed by FNAC were reported and confirmed by biopsy. Three of the cases were in early stages with tumor sizes smaller than 10 mm in diameter and without metastasis. The smears were stained by routine H & E and SudanIII methods. The cytologic findings were described and compared to corresponding histological features, and moreover, compared to chalazion, pilomatrixoma and eyelid basal cell carcinoma. Neither hemorrhage nor infection were found after the examination. Abundant cells were observed in the sebaceous carcinoma FNAC smears. Two types of tumor cells were found: one showed tumor cells differentiating toward sebaceous gland, with large pale cells and vacuolated cytoplasm, the other demonstrated poorly-differentiated cell with dark and irregular nuclei. Numerous vacuoles with inequality of size were found in cytoplasm or in background in all four cases, and the SudanIII stain showed that these vacuoles contained lipid. Some smears demonstrated cells with basaloid, fusiform or squamous features, corresponding to various histopathological types. In contrast, smears of chalazion displayed inflammatory granuloma, containing several types of inflammatory cells without malignant cells. Smears of pilomatrixoma were cellular with three cell populations, which included bland sheets of basaloid cells, nucleated basophilic cells and anucleated keratinized "ghost cells", along with calcific debris. The smears of basal cell carcinoma were typically less cellular, more tightly cohesive and had smaller clusters of uniform hyperchromatic basaloid cells without vacuolization in cytoplasm or background. Overall, the cytological features of eyelid sebaceous carcinoma were distinct from those of chalazion, pilomatricoma and basal cell carcinoma. FNAC is a safe and effective approach for the diagnosis of eyelid sebaceous carcinoma and lipid stain is useful in differential diagnosis. The application of FNAC may be important in reaching an early diagnosis and initial treatment of eyelid nodule.

Eyelid Sebaceous Carcinoma Masquerading as In Situ Squamous Cell Carcinoma

Eyelid Sebaceous Carcinoma Masquerading as In Situ Squamous Cell Carcinoma

Sebaceous carcinoma of the lower eyelid: 2 cases of our experiments

Sebaceous carcinomas of the eyelid are rare neoplasms, accounting for less than 1% of all eyelid tumors, but they frequently metastasize to regional lymph nodes. The five-year survival rate is about 50% among patients who develop metastasis to lymph nodes of the neck. Often, the macroscopic border of a tumor does not match the microscopic findings. Therefore, the tumor should be removed with a safety margin of at least 5 mm, considering the possibility of local recurrence. We experienced two cases of lower eyelid sebaceous carcinoma. After tumor resection, eyelid reconstructions were performed using the malar flap with the hard palate composite graft (periosteum and mucosa). Good results were obtained for these cases. Nowadays, it is rare for otolaryngologists to treat patients with sebaceous carcinoma. However, the chance of head and neck surgeons having to treat these patients is expected to increase in future.

Detection by impression cytologic analysis of conjunctival intraepithelial invasion from eyelid sebaceous cell carcinoma

Objective To demonstrate that conjunctival impression cytologic analysis can detect conjunctival intraepithelial invasion from sebaceous cell carcinoma of the eyelid. Design Observational case series with cytopathologic correlation. Participants Four patients with unilateral blepharoconjunctivitis and biopsy-proven sebaceous cell carcinoma. Methods Impression cytologic analysis specimens were taken from the suspicious area of the bulbar conjunctiva of each patient. Staining of the specimens was performed with a modified Papanicolaou stain. Main outcome measure Observation of the abnormal tumor cells in the collected specimens by bright field microscope. Results The technique of impression cytologic analysis allowed collection and identification of abnormal tumor cells with characteristic cytoplasmic vacuoles. Conclusions Conjunctival impression cytologic analysis successfully detected the ocular surface sebaceous carcinoma cells from the eyelid. However, full-thickness biopsies are necessary to confirm the diagnosis. Judicious use of impression cytologic analysis may facilitate the detection and diagnosis of this invasive tumor.

Sebaceous carcinoma of the eyelid treated with Mohs micrographic surgery

Background: Sebaceous carcinoma is an aggressive neoplasm that commonly arises from the meibomian glands of the eyelids and other sebaceous glands of the ocular adnexa. Historic data indicate a nearly 30% local recurrence rate with standard surgical excision. Excision by means of Mohs micrographic surgery may be more efficacious. However, reports documenting the effectiveness of this technique for the treatment of eyelid sebaceous carcinoma have been limited to a few cases. Objective: We report our experience in the treatment of ocular sebaceous carcinoma with the Mohs fresh tissue technique. Methods: Eighteen patients with a diagnosis of sebaceous carcinoma of the eyelid who underwent resection by means of the Mohs fresh tissue technique during the years 1988-1998 were reviewed. Results: Sixteen of the 18 patients were free of disease after an average follow-up of 37 months (11.1% recurrence rate). One patient who experienced local recurrence also had metastatic disease of the parotid lymph nodes (5.6% metastatic rate). The recurrence and metastasis were noted 9 months after excision. The other patient experienced a local recurrence 19 months postoperatively. Both patients exhibited pagetoid spread and involvement of both the upper and lower eyelid at the time of Mohs excision. Conclusion: Mohs surgery offers excellent results when used as the primary treatment modality for sebaceous carcinoma of the eyelid. When compared with historic series of standard surgical excision, Mohs micrographic surgery has a significantly lower recurrence rate and metastatic rate. (J Am Acad Dermatol 2001;44:1004-9.)

Radiation Therapy for Local Control of Eyelid Sebaceous Cell Carcinoma

Because of previous reports of increased rate of recurrence and mortality after radiation therapy, eyelid sebaceous cell carcinoma has been considered radioresistant. Recent reports of success with primary radiation therapy have been attributed to advancements in irradiating technology and technique. Two cases of eyelid sebaceous cell carcinoma successfully treated with radiation therapy are reported. The techniques used are compared with the techniques described in previous reports, and factors favoring successful treatment are reevaluated. Case series and review of the literature. Two cases of eyelid sebaceous cell carcinoma that underwent radiation therapy are described. Both patients were offered, but refused, surgical excision. One patient received 69 Gy combined superficial and megavoltage x-ray irradiation to the left lower eyelid. The second patient received 59 Gy megavoltage electron beam irradiation to the right upper eyelid. A review of the literature was performed, and Fisher's exact test analysis was used to compare the results of all reported cases treated with < or =55 Gy with those treated with >55 Gy. In both cases, the tumor responded to radiation therapy. One patient died 39 months after treatment, of myocardial infarction. The second patient is without clinical evidence of tumor recurrence 46 months after treatment. Fisher's exact test showed an advantage to patients treated with >55 Gy radiation (p = 0.05). Radiation therapy with an appropriate delivery system is effective as a curative treatment for eyelid sebaceous cell carcinoma when >55 Gy of radiation dose is delivered. It should be considered for patients seeking an alternative to surgical excision.

Malignant tumors of the eyelid: a population-based study of non-basal cell and non-squamous cell malignant neoplasms.

To determine the relative frequencies, average annual incidences, and patient characteristics of non-basal cell and non-squamous cell malignant neoplasms of the eyelid in a defined geographic population. A retrospective study using the Florida Cancer Data System to identify malignant tumors of the eyelid, except for basal cell and squamous cell carcinomas, from 1981 through 1994. Cases were limited to persons who resided within Florida. Incidence of histologically confirmed malignant eyelid tumors. Two hundred six primary malignant eyelid tumors were identified. The 3 most common, in order of frequency, were melanoma, sebaceous carcinoma, and lymphoma. The median age at diagnosis for all patients was 73 years. Only 3 of the 206 malignant neoplasms occurred in blacks. The annual incidence of eyelid melanoma and sebaceous carcinoma in whites older than 20 years was 0.6 and 0.5 per million, respectively. Kaposi sarcoma was the most common type of mesenchymal tumor. Eleven different histologic types of lymphoma were found in the eyelid. Only 2 of 27 lymphomas had T-cell lineage. Malignant tumors of the eyelid other than basal cell and squamous cell carcinoma are uncommon and usually occur in elderly white persons. Primary eyelid tumors of any type are rare in blacks. The risk of a non-basal cell and non-squamous cell malignant neoplasm of the eyelid in Florida is 6.4 times greater for whites than for blacks (95% confidence interval [CI], 2.1-20.2). A variety of B-cell lymphomas can be manifested as primary eyelid tumors.

Management of eyelid sebaceous carcinomas.

We retrospectively studied 14 patients confirmed histopathologically to have eyelid sebaceous carcinoma during 1986-1994. We removed all tumors totally with frozen section controls and performed reconstruction either by primary apposition or transposition flaps. We observed recurrence in 5 patients (35.7%) in whom a surgical margin of either 1 or 3 mm was taken but none in those with a 5-mm surgical margin. At least 5 mm of normal tissue around the tumor should be removed considering the metastatic potential of these tumors.