Sebaceous Cell Research Articles

Expression of retinoic acid-binding proteins and retinoic acid receptors in sebaceous cell carcinoma of the eyelids.

BackgroundSebaceous cell carcinoma of the eyelid is a malignant tumor. However, the pathoetiology of sebaceous cell carcinoma is not clear. Retinoic acid (RA) signaling is essential for skin epidermal differentiation including the eyelids. In this study, we investigate the expression of β-catenin, RA-binding proteins and RA receptors in sebaceous cell carcinoma of the eyelid and try to estimate their influence on its pathoetiology.MethodsRetrospective, noncomparative, consecutive interventional case series. Sixteen cases of eyelid sebaceous gland carcinoma who received tumor excision at our hospital between 2001 and 2011 were included. Immunohistochemical staining for β-catenin, cellular retinoic acid binding protein 1 (CRABP1), cellular retinoic acid binding protein 2 (CRABP2), fatty acid-binding protein 5 (FABP5), retinoic acid receptors (RAR-α, −β, −γ), and retinoid X receptors (RXR-α, −β, −γ) was performed on tissue samples obtained from tumor excision.ResultsOf the 16 sebaceous cell carcinoma cases reviewed, six were male and 10 female. The mean follow-up period was 6.7 ± 3.66 years (range, 0.3–13 years). Of these 16 cases, the expression of β-catenin was significantly increased in sebaceous cell carcinoma cases. CRABP1 was similarly expressed in the sebaceous cell carcinoma and control groups. CRABP2 and FABP5 were expressed in hair follicles of lid skin in both groups, whereas the CRABP2 and FABP5 were aberrantly expressed in the tumor cells of the sebaceous glands. Notably, the expression of retinoic acid receptor (RAR-β) and retinoid X receptors (RXR-β, −γ) was significantly upregulated in sebaceous cell carcinoma of the eyelids.ConclusionsOur findings indicate that retinoic acid signaling is related to the pathogenesis of sebaceous cell carcinoma of the eyelids.

Should Neck Nodes Be Treated in Eyelid Tumors: Unmet Need of Nodal Irradiation

Surgery with adjuvant radiation forms the cornerstone of management. Treatment of neck nodes has remained debatable. We analyzed our database and extracted data of 35 patients with eyelid tumors who underwent treatment at our center between 2006 and 2013. Median age was 55 years (range 30 to 85) with male to female predisposition of 1.05:1. Median duration of symptoms was 12 months. Upper eyelid tumors were 48.5% (17) and lower eyelid tumors were 51.4% (18). Amongst histology sebaceous cell carcinoma 54.2% (19), basal cell carcinoma 22.8% (8), squamous cell carcinoma 11.4% (4), 2.8% (1) each of mucoepidermoid carcinoma, malignant melanoma, adenocarcinoma, poorly differentiated carcinoma. Most commonly performed imaging modality was contrast-enhanced computed tomography of orbit (CECT) 71.4% (25), followed by positron emission tomography 8.5% (3), magnetic resonance imaging 2.85% (1). Staging was according to TNM was stage 0 2.85% (1) IA 22.8% (8), IB 2.85% (1), IC 11.4% (4), II 5.7% (2), IIIA 28.57% (10), IIIB 17.1% (6) IIIC 8.5% (3). In management 91.4% ( 32) underwent surgery, 5.7 % (2) received palliative radiation therapy (RT), 2.857% ( 1) radical RT. Amongst 32 who underwent surgery patients 59.37% (19) received adjuvant RT. Out of 32, 50% (16) underwent exentration and 75% (12) had neck dissection of which 41.6% (5) were type 1, 41.6% (5) were type 3, and 16.65 (2) were type 2. Of 12 patients with neck dissection 66.6% (8) had intra-parotid lymph node group involved, 16.6% (2) in level Ib, 8.3% (1) in level II. Most commonly sebaceous cell carcinoma was associated with positive lymph nodes 75% (9), 8.3% (1) by squamous and malignant melanoma. RT was performed with electrons with corneal tungsten shield in 88% (22) and by photons in 12% (3). Postoperative dose employed was 60 Gray in 30 fractions over 6 weeks. Short term toxicity due to radiation was conjunctivitis in 20% (5), dryness of eyes 20% (5), dermatitis 16% (4). Of 33 patients treated with radical intent, 48.48% (16) had recurrence of which most common histology to recur was sebaceous cell carcinoma 56.255 (9), squamous 12.5% (2). 56.25% (9) with recurrence did not receive postoperative RT (all had local recurrence), 43.75% (7) had recurrence after RT mostly recurred in nodal region 57.1% (4). Salvage therapy most commonly employed was surgery 56.25% (9), followed by RT 43.75% (7). 25% (4) had re-recurrence salvaged with surgery and postoperative radiation. Median duration of follow-up was 24 months with 71.42% (25) with no evidence of disease and 28.57% (10) with progressive disease at last follow-up. Neck dissection and elective neck irradiation should be considered in certain histology like sebaceous and squamous especially if T stage >T3.

Recurrent Nasal Sebaceous Carcinoma in Human Immunodefiency Virus/ Hepatitis B Virus (HIV/HBV) Coinfection Patient: A Case Report

Background: Human Immunodefiency Virus (HIV) since the first case was reported is recognized as a major risk factor for development of different types of malignancies, Sebaceous carcinoma is a rare and aggressive form of cutaneous carcinoma and very rare in HIV Patients. Method: A case report and literature review of 46 years old male, known to have HIV/HBV coinfection presented with a history of four months of gradual growth Nasal mass. Result: Excisional biopsy performed for the nasal mass and histopathology examination showed sebaceous cell carcinoma, Surgical removal of the nasal mass was done and nasal reconstruction with right paramedian forehead flap plus full thickness skin graft taken from the abdomen for reconstruction of the inner nose also was done, after two years patient came back with recurrent at same site. Conclusion: sebaceous cell carcinoma is an extremely rare in HIV patients, but should be considers for any skin tumor in HIV patient, follow up also needed for the risk of recurrent.

Eyelid Tumors: Clinical Data from an Eye Center in Ankara, Turkey

The aim of the study was to explore the distribution of eyelid tumors in Ankara, the capital city of Turkey, from a histopathological point of view. Medical records of 1,502 patients who had eyelid surgery because of tumoral lesions were retrospectively reviewed after obtaining institutional review board approval. A total of 1,541 lesions with histopathologic diagnosis were included. Inflammatory tumoral lesions were excluded. The lesions were categorized into three groups according to the origin: epidermal, adnexal tumors and 'others', including melanocytic, neural and vascular lesions. Of the total of 1,541, 908 lesions were epidermal in origin. Only 22 (1.5%) were malignant, and 6.0% was premalignant lesions such as actinic keratosis and Bowen's disease. Twenty-one of 22 malignant lesions were basal cell carcinoma. There was only one patient with squamous cell carcinoma and no sebaceous cell carcinoma. Among the benign tumors (92.5%), squamous papilloma was the most frequent (21.8% of all lesions). The other frequent lesions were nevus (17.6%), seborrheic keratosis (17.3%), hydrocystomas (10.6%), xanthelasma (7.6%) and epidermal cysts (7.2%). The results of this study are in accordance with published literature. The absence of sebaceous cell carcinomas needs to be stressed.

Sebaceous Gland Carcinoma Masquerading as a Chalazion in a 18 Year Old Girl

Neoplasms of the sebaceous glands may masquerade as benign lesions resulting in delay in diagnosis. Their presentation may vary from sebaceous cell adenoma to sebaceous cell carcinoma. Worldwide, sebaceous cell carcinoma is the second most common eyelid malignancy after basal cell carcinoma. It commonly occurs in seventh decade of life. We report the clinical and histopathological findings of an 18-years-old girl presenting to us with sebaceous cell carcinoma in absence of any predisposing factors.

Apocrine hidrocystoma of eye lid mimicking as sebaceous cell carcinoma

Apocrine hidrocystoma of eye lid mimicking as sebaceous cell carcinoma

Extraocular sebaceous carcinoma of neck: A case Report

Context: Sebaceous cell carcinoma is a malignant neoplasm, rarely recognized in extra ocular sites. This neoplasm is aggressive in 29% of patients, lymph node and visceral metastasis are common. Its prognosis depends on early diagnosis of lesion. Clinical & Diagnostic features: An 49 year old female had slow growing nonulcerative subcutaneous nodule on the nape of neck of 9 months duration. On FNAC cytological findings favoured a benign skin adenexal tumor with focal nuclear atypia. On histological examination it was diagnosed as a poorly differentiated sebaceous carcinoma. Conclusion: Extra ocular sebaceous carcinoma is a rare neoplasm. It is difficult to diagnose as it has diverse clinical presentations, histologic patterns and complicated nomenclature. We will discuss the incidence, clinical, and histological findings along with the prognosis of this aggressive neoplasm. Keywords: Extra-ocular, Sebaceous cell carcinoma, Histopathology

Sebaceous Cell Carcinoma: Wide Histological Spectrum and Correlation to Prognosis. A Case Report and Review of the Literature

Sebaceous cell carcinoma (SCC) is the second most common eyelid malignancy among Caucasians, next to Basal cell carcinoma (BCC). It is an uncommon malignant neoplasm, and there are several reports describing the multiple clinical and histopathological presentations of SCC. Given its rarity, diagnosing SCC remains a challenge for ophthalmologists and pathologists, especially when conducting incisional biopsies. A 66-year-old male presented with a recurrent right upper eyelid mass for 4 years. The lesion recurred 4 times, and a biopsy was performed twice. In the first biopsy, a mild cell atypia was observed; the second biopsy was negative for atypia or cancerous cells. The patient was followed-up closely and in the 4th recurrence, a full thickness biopsy was performed. Histopathologically, areas of well-differentiated SCC were observed, as well areas of poorly differentiated SCC resembling BCC, squamous cell carcinoma in situ, and mucoepidermoid carcinoma. We highly recommend clinical and pathological suspicion of SCC in clinical cases of recurrent chalazion, treatment-resistant blepharoconjunctivitis, and undifferentiated malignant tumors of the eyelid present late in life.

Characterization of the sebocyte lipid droplet proteome reveals novel potential regulators of sebaceous lipogenesis

Lipid metabolism depends on lipid droplets (LD), cytoplasmic structures surrounded by a protein-rich phospholipid monolayer. Although lipid synthesis is the hallmark of sebaceous gland cell differentiation, the LD-associated proteins of sebocytes have not been evaluated systematically.The LD fraction of SZ95 sebocytes was collected by density gradient centrifugation and associated proteins were analyzed by nanoliquid chromatography/tandem mass spectrometry. 54 proteins were significantly enriched in LD fractions, and 6 of them have not been detected previously in LDs. LD fractions contained high levels of typical LD-associated proteins as PLIN2/PLIN3, and most proteins belonged to functional categories characteristic for LD-associated proteins, indicating a reliable dataset. After confirming expression of transcripts encoding the six previously unidentified proteins by qRT-PCR in SZ95 sebocytes and in another sebocyte line (SebE6E7), we focused on two of these proteins, ALDH1A3 and EPHX4. While EPHX4 was localized almost exclusively on the surface of LDs, ALDH1A3 showed a more widespread localization that included additional cytoplasmic structures. siRNA-mediated downregulation revealed that depletion of EPHX4 increases LD size and sebaceous lipogenesis. Further studies on the roles of these proteins in sebocyte physiology and sebaceous lipogenesis may indicate novel strategies for the therapy of sebaceous gland-associated diseases such as acne.

Periocular Sebaceous Cell Carcinoma Following Chemical Burn

This study reports a unique case of a Marjolin ulcer in a patient who presented with periocular sebaceous cell carcinoma 16 years after a lye chemical burn. A 68-year-old woman presented with a long history of irregular and tender right upper and lower eyelid margins, periocular erythema, madarosis, trichiasis, ptosis, and chemosis, occurring many years after chemical burn to the area. After eyelid biopsy established the diagnosis of sebaceous cell carcinoma, subsequent map biopsies of the conjunctival surface revealed extensive sebaceous cell carcinoma with pagetoid spread, necessitating anterior exenteration for definitive treatment. This report describes the first case in which a sebaceous cell carcinoma has arisen in the area of a chemical burn. Sebaceous cell carcinomas should be included in the spectrum of Marjolin ulcers, and ophthalmologists should be aware of this entity when evaluating patients with a history of a burn to the eyelids.

Morphogenesis of eyelid meibomian gland

AbstractPurpose Dysfunction of Meibomian gland is the primary cause of dry eye. The purpose of our study is to understand embryogenesis for a better understanding of the pathophysiology of these diseases.Methods Eyelids were obtained from 22 fetuses formalin fixated of 10‐34 weeks gestational age (GA) with approval of Ethics Committee. These 88 eyelids were processed with sections 5µm thick and analyzed by light microscopy after staining with hematoxylin‐phloxine‐saffron and PAS reaction. For each sample, different morphological criteria were investigated: evaluation of glandular bud, sebaceous gland differentiation, arborization of the gland, opening of excretory duct.Results Histological analysis revealed that up to 13 weeks of GA, the fetal lid consists of fine vascular structures in a loose mesenchyme, under a very thin epithelium. At 14 weeks of GA, a first process of the excretory duct is individualized as a cell invagination extending from the eyelid margin. Sebaceous cell differentiation is identified at 15 weeks of GA. The excretory canal keeps its maturation to appear as a small cellular cord, unique and full around 16 weeks of GA, glands begin its buds arborization at 19 weeks of GA. This channel gradually widens and expands, appearing always blocked by a plug of squamous cells and keratin cuticle at 22 weeks of GA. The plugging lasts until 34 weeks of GA.Conclusion Glandular structures involved in tear secretion appear in fetus around fourteen weeks of gestation. The Meibomian glands extend its maturation after birth. Further studies will allow a better understanding of the physiopathology of dry eye.

Primary Adenocarcinoma of the Lacrimal Gland With Sebaceous Differentiation in a 4-Year-Old Child

Primary adenocarcinoma of the lacrimal gland with sebaceous differentiation is an extremely rare tumor. Only 11 cases have been reported in the literature, none in children. A 4-year-old girl presented with a rapidly progressing mass in the left lacrimal gland fossa. An incisional biopsy followed by partial orbital exenteration confirmed the diagnosis of adenocarcinoma with sebaceous cell differentiation. Currently, no previous reports of this malignancy in childhood have been published. This case underscores the necessity of expanding the presenting age that adenocarcinomas with sebaceous differentiation of the lacrimal gland can occur.

Sebaceous Carcinoma of Lacrimal Caruncle in a Chinese Patient

To describe a case of sebaceous carcinoma of the caruncle and review relevant literature to raise awareness about this rare disease. A 63-year-old Chinese man presented with a nontender mass that had developed within the right lacrimal caruncle more than 3 years previously and had been growing in size. The patient was admitted to the hospital, and no systemic diseases were noted on physical and instrumental examinations. The mass was removed intact, and 10 small map biopsies of the surrounding conjunctiva and deeper tissues were performed. Thereafter, 0.04% mitomycin C was applied to the surgical defect for 5 minutes before repair by conjunctival autografting. The gross specimen was observed to be firm and yellow. Microscopic examination revealed that the tumor consisted of lobules, composed of pleomorphic vacuolated cells with central necrosis. The pathologic diagnosis was a well-differentiated sebaceous cell carcinoma of the caruncle that did not extend to the deep surgical margins. Moreover, no tumor recurrence was noted 12 months after surgery. The occurrence of sebaceous cell carcinoma in the caruncle is rare. In general, this neoplasm is often both clinically and histopathologically misdiagnosed as a benign condition, resulting in both a delay in correct diagnosis and increased morbidity and mortality. Therefore, this malignancy should be considered in the differential diagnosis of caruncular lesions. The suspected neoplasm should be removed by margins that are as wide as possible; map biopsies are considered to be useful to rule out the subclinical spread of the tumor.

Sebaceous carcinoma over cheek: A rare presentation

Sebaceous carcinoma, an uncommon cutaneous tumor first described by Allaire in 1891. This arises mostly from sebaceous glands in the skin and thus may arise anywhere in the body where these glands exist. Approximately, 75% of these tumors arise in the periocular region, which is rich in sebaceous glands. Fewer than 120 cases of sebaceous cell carcinoma have been reported at the extraocular sites as in our case.

Rare Tumour - Sebaceous Carcinoma of the Scalp

Sebaceous carcinoma (SC) is a rare carcinoma arising from sebaceous gland divided into ocular and extra ocular. Ocular SC is more common than extra ocular. This tumour has a high incidence of recurrence and metastasis. Due to its rarity, it is often difficult to arrive to a diagnosis. Early diagnosis and treatment is crucial. Definitive diagnosis is only by histopathological examination. We are presenting a case of sebaceous carcinoma arising from the scalp. I. Introduction Sebaceous carcinoma (SC) is a rare aggressive malignant tumour derived from the adnexal epithelium of sebaceous glands. It is most commonly seen in the orbital region(2). Extra orbital sebaceous cell carcinoma is extremely rare which commonly occurs on head and scalp due to the abundant sebaceous glands(3). Most sebaceous gland carcinomas have no obvious aetiology and only a few are associated with Muir-Torre syndrome(MTS). This tumour is thought to arise from sebaceous glands in the skin and thus, may crop up anywhere in the body, where these glands exist including the genitalia. SCtraditionally classified into 2 groups, those arising from the ocular adnexa, particularly the Meibomian glands and glands of Zeiss, and those arising in extra ocular sites(4). Ocular SC represents 0.2% to 0.8% of all eyelid tumours and 1% to 5.5% of all eyelid malignancies(6). It is estimated that approximately 25% of all reported cases of sebaceous carcinoma occur in extra ocular site. It has been reported that more than 70% of sebaceous carcinomas are located in the head and neck regions, where sebaceous glands are most commonly located (5).These tumours have a high incidence of local recurrence and regional metastasis. Earlydiagnosis is crucial in reducing the morbidity and mortality associated with the tumour(6). This is a case report of an elderly manwith a sebaceous carcinoma of the scalp.

Overview of conjunctival and eyelid tumours

AbstractIn this part of the course an overview will be given of the most common and most important conjunctiva and eyelid tumors ( basal cell carcinoma, squamous cell carcinoma, sebaceous cell carcinoma, malignant melanoma). For each disease clinical‐pathologic correlations will be emphasized. Typical and atypical characteristics will be shown. In most cases the clinician finds the correct diagnosis, but even then it is important to investigate the section margins and the degree or details of the tumor. In rare cases a surprise in diagnosis is found and some important examples of these will be given, with also the useful consequences on the clinical follow‐up of these patients. Correct diagnosis can also be useful in non‐malignant processes and examples will be given. A short overview will be given of newer techniques and diagnostic possibilities.

PLIN2, the major perilipin regulated during sebocyte differentiation, controls sebaceous lipid accumulation in vitro and sebaceous gland size in vivo

BackgroundLipid synthesis and storage are accomplished by lipid droplets (LDs). The perilipin family of LD-associated proteins, comprising 5 members (PLIN1–PLIN5), has been well characterized in adipocytes but not in sebocytes, epithelial cells in which LD formation is a key feature of the cellular differentiation. MethodsPerilipin expression in the sebaceous gland cell line SZ95 and in human sebaceous glands was studied by qRT-PCR, Western blots, and immunohistochemistry. Lipid accumulation was evaluated by Nile red staining and mass spectrometry. ResultsPLIN2 and PLIN3 are the most abundant perilipins in undifferentiated sebocytes. Induction of lipogenesis by linoleic acid (LA) resulted in increased transcript levels of all perilipins except for PLIN3 and in a time-dependent increase of PLIN2 protein. Nile red staining revealed that siRNA-mediated downregulation of PLIN2 significantly impaired basal and LA-induced lipid accumulation. Mass spectrometry revealed PLIN2 deficiency to cause a reduction in the amount of several specific lipid fractions, including di- and triacyl-glycerol esters, phosphatidylcholine lipids, and ceramides in sebocytes under basal conditions. In contrast, PLIN2 downregulation exerted a statistically significant inhibitory effect only on the accumulation of specific LA-induced triglycerides. PLIN2-deficient mice showed normal morphology of sebaceous glands. However, their sebaceous glands were significantly reduced in size and showed less cell proliferation. ConclusionsPLIN2 is the major perilipin regulated during sebocyte differentiation in vitro. PLIN2 is also important for sebaceous lipid accumulation in vitro and regulates sebaceous gland size in vivo. General significanceOur study provides the first systematic analysis of LD-associated proteins in sebocytes.

Population‐based analysis of prognostic indicators in sebaceous carcinoma of the head and neck

Due to the rarity of sebaceous carcinoma of the head and neck, few large series have been reported and prognostic factors remain largely undetermined. This study presents prognostic factors in survival in sebaceous carcinoma of the head and neck. Retrospective analysis was performed using the Surveillance Epidemiology and End Results (SEER) database for patients diagnosed with sebaceous carcinoma of the head and neck (SCHN). Clinicopathologic, treatment data, and 5-year disease specific survival were analyzed using univariable and multivariable regression analysis and Kaplan-Meier methodology. Of the 1,433 patients identified to have SCHN, 16 were node-positive (1.14%). On multivariable analysis, independent prognostic indicators were: age at diagnosis (HR = 1.03, P = .021), tumor grade (HR = 4.97, P = .038), and distant metastasis (HR = 7.52, P = .006). Nodal metastasis occurred exclusively with poorly or undifferentiated tumors and was not a significant prognostic factor on multivariable analysis. Elderly patients and patients with poorly differentiated tumors and/or distant disease at presentation have the highest risk of disease-specific mortality. Lymph node metastasis does not appear to be an independent prognostic factor in sebaceous cell carcinoma.

Postauricular sebaceous cell carcinoma

Introduction: Sebaceous cell carcinoma is an aggressive tumor arising from the sebaceous glands. It is relatively rare tumor and seen almost exclusively on the eyelids (75%). Despite the high concentration of sebaceous glands over head and neck region, true neoplasm, i.e. sebaceous cell adenoma and carcinomas are infrequent. It accounts for just 0.2–0.7% of all eyelid tumors in USA and very few cases that have originated in areas other than the eyelids have been reported. Case Report: A 70­year­old male presented with complaints of rapidly growing swelling (3x4 cm), on the right post auricular region, since one and half months. The patient developed discharging ulcer over the swelling associated with progressive tinnitus and hoarseness of voice, since last twenty days. Fine needle aspiration cytology (FNAC) was advised, which suggested the diagnosis of sebaceous cell carcinoma and excision biopsy was done. Histopathological examination of excised tissue confirmed the diagnosis. Conclusion: Extraorbital sebaceous cell carcinoma is an aggressive and invasive malignancy. It clinically mimics other diseases and is difficult to diagnose. Hence, an accurate and prompt diagnosis is crucial because of its fulminant course, serious associations with Muir–Torre syndrome and high potential for regional and distant metastasis.

Sentinel Lymph Node Biopsy in Malignant Eyelid Tumor: Hybrid Single Photon Emission Computed Tomography/Computed Tomography and Dual Dye Technique

To study the utility of hybrid single photon emission computed tomography / computed tomography (SPECT/CT) scan and dual-dye technique in identification of the sentinel lymph node (SLN) in patients with an advanced malignant eyelid tumor. Nonrandomized prospective interventional study. setting: A tertiary eye care center. study population: Patients with an advanced malignant eyelid tumor without clinically involved regional lymph nodes. intervention: SLN biopsy was performed using dual-dye technique (a combination of radiotracer and vital blue dye) following localization by SPECT/CT. main outcome measures: Localization of SLN in the regional node basin by hybrid SPECT/CT scan; SLN identification rate using dual-dye technique; SLN positivity rate; false-negative rate; and complications, if any, of SLN biopsy. Sixteen patients of biopsy-proven eyelid malignancy (7 squamous cell carcinomas [43.75%], 5 sebaceous cell carcinomas [31.25%], and 4 malignant melanomas [25%]) were included in the study. Preoperative localization of SLN was performed using SPECT/CTin 12 patients. SLN biopsy using dual-dye technique was performed in 16 patients. SPECT/CT accurately localized SLN in 11 out of 12 patients. The preauricular region was the most common site of SLN. SLN identification rates for dual-dye, radiotracer, and blue dye techniques were 100% (16/16 patients), 100% (16/16 patients), and 87.5% (14/16 patients), respectively. SLN showed metastasis in 2 patients (12.5%). On follow-up, 1 patient developed cervical lymph node metastasis, thus giving a false-negative rate of 7.14%. There were no complications associated with SLN biopsy. Accurate preoperative localization of SLN in relation to adjacent anatomic structures using SPECT/CT aids in intraoperative identification of SLN. SLN biopsy should be considered in patients with eyelid tumors at significant risk for metastasis who have clinically negative nodal basins. Dual-dye technique is safe and feasible in advanced eyelid tumors. Blue dye technique can be used for SLN biopsy in settings where nuclear medicine facilities are not available, albeit with a lower SLN identification rate. Detection of metastasis in SLNs in ∼12% of cases emphasizes the utility of SLN biopsy in accurate staging and treatment of eyelid malignancies.