Sebaceous Gland Carcinoma Research Articles

β-Catenin in Canine Skin: Immunohistochemical Pattern of Expression in Normal Skin and Cutaneous Epithelial Tumours

In normal adult skin, β-catenin is a structural component of the intercellular junction and the Wnt/β-catenin pathway plays a key role in the regulation of cutaneous homeostasis, particularly in the maintenance of hair follicle stem cells. No data are available on the expression pattern of β-catenin in normal canine skin and in canine cutaneous epidermal and follicular tumours. The present study used immunohistochemistry to determine β-catenin expression in four samples of normal canine skin and 62 cutaneous epithelial tumours (14 epidermal, 30 follicular and 18 glandular). β-catenin expression was localized to the nucleus of matrical and dermal papilla cells in anagen hair follicles and was also found in scattered cells of the outer root sheath, suggesting that these follicular epithelial cells may have a high proliferative potential. Nuclear labelling, considered a hallmark of activation of the Wnt/β-catenin signalling pathway, was observed in canine follicular tumours with matrical differentiation (100% of cases of trichoepithelioma and pilomatricoma), suggesting that a possible mutation of the canine CTNBB1 gene may underlie these tumours. In contrast, malignant tumours (squamous cell carcinoma, basal cell carcinoma, sebaceous and apocrine gland carcinoma and epithelioma) were characterized by reduction/loss of β-catenin membrane labelling compared with normal cutaneous epithelial cells and benign tumours, suggesting that reduction/loss of β-catenin expression is important in the acquisition of the malignant phenotype and may have a role in the infiltration and metastasis of these tumours.

Primary sebaceous gland carcinoma of the bulbar conjunctiva without involvement of eyelid: A clinical dilemma

Sebaceous gland carcinoma usually arises from the meibomian or Zeis glands within the eyelid, but tumor arising primarily from the conjunctiva, especially bulbar conjunctiva, is a rarity. We hereby report a case of a 50-year-old female who presented with a painless mass in the inferior limbus, encroaching the cornea and hanging over the lower eyelid without involving it. Imprint cytology was suggestive of adenosquamous carcinoma. Management consisted of wide local excision, cryotherapy to tumor bed, and topical 5-fluorouracil (5-FU) 1% preoperatively and postoperatively. Histopathologic analysis was in favor of sebaceous gland carcinoma. This case suggests that although sebaceous gland carcinoma commonly originates as a lid tumor, it can present as a bulbar conjunctival mass. Topical 5-FU is a viable and efficient cost-effective alternative for neo-adjuvant and adjuvant treatment of sebaceous gland carcinoma.

′Switch flap′ for full thickness upper eyelid reconstruction

Sebaceous gland carcinoma is an aggressive, uncommon, cutaneous malignancy. This tumour can arise anywhere in the body; approximately 75% of these tumours arise in the periocular region. The diagnosis and management of these malignancies often tend to get delayed because they are frequently mistaken for more common benign entities. Surgery has been and remains the primary treatment modality for sebaceous gland carcinomas. The resultant surgical defects following tumour excision generally tend to be full thickness and reconstructions of such defects pose significant challenges. These defects are conventionally reconstructed by the traditional bridging (eyelid sharing) procedures, that is, the Cutler-Beard flap and its modifications. The ‘Switch flap’ is an alternative eyelid sharing procedure; however, it is not very widely practiced. We recently used this procedure to reconstruct a large full-thickness upper eyelid defect with a satisfactory cosmetic and functional outcome.

Recurrent sebaceous gland carcinoma of eyelid previously diagnosed as basal cell carcinoma: case report

Sebaceous gland carcinoma (SGC) of the eyelid is a highly malignant neoplasm that arises from the meibomian glands, glands of Zeis, and sebaceous glands of the skin. The characteristics of this disease are high recurrence rate, significant metastatic potential, and notable mortality rate, which are quite different from basal cell carcinoma (BCC). We report the case of a 37-year-old woman with the history of left lower eyelid BCC (diagnosed 9 years ago), who had left parotid lymph nodes metastases and local recurrence twice. The chief complaint during visit was a left upper eyelid swelling mass noted for 3 months. She received salvage ablation surgery later. The final pathologic report is SGC. The diagnosis corresponds to the clinical presentation of this patient at last. The delay between initial examination and final diagnosis in this patient is about 9 years, but operation and concurrent chemotherapy and radiotherapy were performed after left parotid lymph nodes metastasis was noted. Although there was still local recurrence after concurrent chemotherapy and radiotherapy, the patient is still alive without distant metastasis. In this article, we would discuss the differences of the pathologic characters, treatment, and prognosis between SGC and BCC.

Clinicopathologic study of malignant eyelid tumours

Background: Early diagnosis of malignancy of eyelids can save the visual system from metastasis. The study was carried out to determine its pattern of prevalence, which will be a milestone for the ophthalmologists to design a clinical strategy for early intervention.Methods: Retrospectively, we studied 155 eyelid cases from 2000 to June 2009 carried out through histopathologic confirmation. The cases other than malignancy were excluded.Results: A total of 37 malignant eyelid tumours were seen. There were 40.6 per cent male cases. Sebaceous gland carcinoma was the commonest (40.5 per cent) finding, followed by squamous cell carcinoma (27 per cent), basal cell carcinoma (24.3 per cent), basosquamous carcinoma (5.4 per cent) and malignant melanoma (2.7 per cent).Conclusions: As the most common tumour in the region, sebaceous gland carcinoma might be due to geographical and environmental variations and requires immediate consultation and histopathologic diagnosis of lid lesions above 40-years of age for treatment strategies.

Topical mitomycin C chemotherapy in the management of ocular surface neoplasia: a 10-year review of treatment outcomes and complications

IntroductionThe use of topical mitomycin C (MMC) has gained popularity in the management of ocular surface neoplasia. The aim of this study is to determine outcomes and complications following such...

Reverse Modified Hughes Procedure for UpperEyelid Reconstruction

To describe the outcome of the reverse modified Hughes procedure for the reconstruction of extensive full-thickness defects of the upper eyelid. Seventeen cases of full-thickness extensive upper eyelid defects were reconstructed using the reverse modified Hughes procedure. Extensive defects were characterized as those with a width of 80% or more of the eyelid after tumor excision. Posterior lamella reconstruction was achieved using a pedicled tarsoconjunctival flap from the donor lower eyelid. For anterior lamella reconstruction, the orbicularis oculi muscle superior to the defect was mobilized and transposed over the tarsoconjunctival flap. A cutaneous advancement flap using redundant skin adjacent to the defect or a free postauricular skin graft in cases of insufficient lax skin was used to cover the orbicularis oculi muscle flap. The tarsoconjunctival pedicle was divided 3 to 8 weeks after the primary operation. Seventeen patients from 40 to 81 years of age were included in the study. The underlying diagnoses included sebaceous gland carcinoma (13), squamous cell carcinoma (3), and Merkel cell carcinoma (1). Follow-up of 6 to 80 months revealed no cases of flap ischemia or identifiable necrosis after division. The functional and aesthetic outcomes were generally satisfactory throughout follow-up. Postoperative complications included epithelial keratopathy (4), lagophthalmos (3), upper eyelid entropion (2), granuloma formation (2), and lower eyelid entropion (1). The reverse modified Hughes procedure with orbicularis muscle mobilization was successful in repairing extensive full-thickness upper eyelid defects greater than 80% of the eyelid width. The mobilization of the orbicularis oculi muscle, with its robust vascular supply, enhances the viability and cosmetic appearance of the reconstructed eyelid.

Advanced upper eyelid sebaceous gland carcinoma with deep orbital extension.

Sebaceous gland carcinomas (SGC) are highly malignant lid tumors which originate from meibomian glands and rarely from the gland of Zeis, sebaceous gland of caruncle, eyebrows and periocular skin. In many cases correct diagnosis of SGC is delayed because of its ability to masquerade as a variety of other ocular conditions.A forty year old male presented with a left upper eyelid swelling with an ulcerated wound on its nasal aspect. A differential diagnosis of sebaceous gland carcinoma or preseptal cellulitis was made. Contrast enhanced computed tomography showed an ill defined soft tissue density mass in the left orbit encasing the whole of the optic nerve. A total exentration was performed. A diagnosis of meibomian gland carcinoma was confirmed on histopathology.This is a report of an advanced sebaceous gland carcinoma with deep orbital extension. An early diagnosis and appropriate treatment may decrease the long term morbidity and extend the survival rate of such patients.

Sebaceous gland carcinoma of the eyelid

Sebaceous gland carcinoma, commonly arises in the periocular area, is an uncommon condition. It represents 1–5.5% of eyelid malignancies and is considered to be the third most common eyelid malignancy after basal cell and squamous cell carcinomas, although few reports placed this tumor as second most common after basal cell carcinoma. It usually affects elderly women and characterized by high rate of local recurrence, regional, and distant metastases. A delay in diagnosis, which can be attributed primarily to ability of this tumor to masquerade as more benign conditions, often leads to inappropriate management with increased morbidity and mortality rates. In this study, the authors discuss key elements of the primary disease and therapeutic options available to treat such devastating problem.

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.

Social Challenges of Cancer Patients With Orbitofacial Disfigurement

Patients who undergo orbital exenteration often experience social problems because of their facial disfigurement. The authors studied the interaction of cancer patients who had undergone orbital exenteration with family members and friends (primary groups) and with acquaintances and strangers (secondary groups) in small and large groups. In-depth telephone interviews were conducted with 12 patients treated at a cancer center (7 men and 5 women aged 51-81 years) and 12 family members (8 spouses and 4 children or siblings). Three patients had adenoid cystic carcinoma of lacrimal gland, 3 had squamous cell carcinoma of conjunctiva/eyelid, and 1 each had conjunctival melanoma, eyelid sebaceous gland carcinoma, transitional cell carcinoma of lacrimal sac, adenocarcinoma of orbit, neuroendocrine carcinoma of orbit, and basal cell carcinoma of eyelid. Time from orbital exenteration to interview ranged from 8 months to 36 years (median, 44 months). Two patient groups were identified according to comfort in interactions with acquaintances and strangers. Always comfortable patients were always at ease. Occasionally comfortable patients were at ease in large groups in situations of "benign neglect" and in small groups when they received "sympathy"; were uncomfortable in large and small groups when episodes of "intrusion" occurred; and had mixed responses to benign neglect in small groups and sympathy in large groups. Both patient groups felt comfortable with family members and friends. Patients who will undergo orbital exenteration should be warned about possible difficulties with social interactions. Healthcare personnel should be trained to help patients and family members prepare for such difficulties.

Development and Progression of a Periorbital Sebaceous Gland Carcinoma in situ

Development and Progression of a Periorbital Sebaceous Gland Carcinoma in situ

Expression of oestrogen and progesterone receptors in canine sebaceous gland tumours

Sebaceous gland oestrogen alpha (ERalpha) and progesterone (PR) receptor expression was examined immunohistochemically in 26 and 32 dogs respectively with sebaceous gland hyperplasia/adenomas, epitheliomas and carcinomas, and in the glands of 10 healthy controls. The mean percentage of ERalpha positive nuclei in control sebaceous glands was 21.31% compared with 11.5% in hyperplasia/adenoma-type lesions, although these values were not statistically different. In sebaceous gland epitheliomas and carcinomas, positive basal cells represented 7.86% and 3.53% of neoplastic cells respectively and these mean percentages were significantly lower in epitheliomas (P < 0.024) and carcinomas (P < 0.015) than in controls. The mean percentage of PR-positive nuclei in control sebaceous glands was 23.96%, similar to the 22.07% found in hyperplasia/adenoma-type lesions. In sebaceous gland epitheliomas and carcinomas, positive cells were scarce and represented 13.5% and 4.06% of neoplastic cells respectively. Differences in the percentage of positive cells between normal and pathological glands reached statistical significance for carcinomas (P < 0.043). In the control group there was greater PR (P < 0.001) and ERalpha expression (P < 0.014) in sebaceous glands in female dogs. The PR and ERalpha immunoreactivity in each category of neoplastic lesions could not be analysed because sample size was too small but when all the sebaceous gland tumours were grouped and analysed, no sex difference was found. The results suggest that oestrogen and progesterone receptor expression is reduced in some canine sebaceous gland tumours. These changes may represent a contributing factor for tumour growth or simply be a consequence of tumour progression.

Acellular Dermal Graft (AlloDerm) for Upper Eyelid Reconstruction After Cancer Removal

To report the use of AlloDerm for reconstruction of large upper eyelid defects in cancer patients. The clinical records of all patients who had AlloDerm as part of their upper eyelid reconstruction between July 2005 and July 2006 at a single institution were reviewed. Functional and cosmetic outcomes and postoperative complications were assessed. Two patients had recurrent sebaceous gland carcinoma, 2 had melanoma, and 1 had squamous cell carcinoma. The upper eyelid defect involved the full thickness and entire width of the upper eyelid in 4 patients and full thickness and two thirds of the upper eye eyelid in 1 patient. The reconstructive procedure included a modified Cutler-Beard procedure using AlloDerm as the posterior lamellar sandwich graft in all 5 patients. One patient had early postoperative adjuvant radiation therapy to the upper eyelid. Three patients had excellent functional and cosmetic outcome; 2 patients had satisfactory outcomes. Two patients had residual exposure keratopathy. Allergic reaction to AlloDerm, infectious transmission, and immunologic rejection were not encountered at the time of this report (mean follow-up time = 13 months). AlloDerm can be used as an alternative sandwich graft material to replace the tarsus for reconstruction of large upper eyelid defects using a modified Cutler-Beard procedure.

Five-Year Cycle of Basal Cell Carcinoma Management Re-audit

Aim: To complete a 5-year audit cycle for all malignant lid tumours treated by one consultant (Stafanous) and re-audit the first work done in 2000 and 2001/2002. The main aim was to find out the recurrence rate and presence of new lesions in 5-years’ follow-up and determine whether it is safe to discharge patients after histological clearance and satisfactory reconstruction outcome rather than 5 years’ follow-up.Method: Retrospective audit from January 2000 to December 2006. The collected data was: Site and type of lesions, type of surgery, recurrence rate and new lesions.Results: Out of 112 cases identified, 104 were Basal Cell Carcinoma (BCC), 4 Squamous Cell Carcinoma (SCC), 3 Sebaceous Gland Carcinoma (SGC) and 1 Malignant Melanoma (MM). 68/112had biopsy before definitive surgery and 44/112 had surgery without preceding biopsy. 54/112 had one stage surgical excision and 58/112 had modified Moh’s surgery in 2–4 theatre sessions. Only 1/112 had recurrence at the same site during the follow-up period and 5 had new lesions at different periorbital sites.Conclusion: There was no evidence of significant recurrence to justify the 5-years’ follow-up. Patients with histologically cleared tumours and satisfactory functional and cosmetic reconstruction outcome can safely be discharged to their GP and should be re referred for new lesions. The functional and cosmetic outcome of the reconstruction was generally satisfactory.

Mitomycin‐C as adjuvant therapy in the treatment of sebaceous gland carcinoma in high‐risk locations

To report on the use of Mitomycin-C as adjuvant therapy to excision and cryotherapy in patients with sebaceous gland carcinoma (SGC) in high-risk locations. Retrospective, consecutive, case series. Three patients with SGC of the upper palpebral conjunctiva or caruncle, but without clinical pagetoid spread. Following excision and double freeze-thaw cryotherapy, patients with histology demonstrating SGC of the ocular surface were treated with topical Mitomycin-C (0.04%). Follow-up was conducted over an average of 30 months (range: 24-37 months). Postoperative evidence of local recurrence, lymph node or distant organ metastasis. No patients had evidence of local recurrence or systemic disease. Wide surgical excision with cryotherapy is the basis of treatment of SGC without pagetoid spread. The use of Mitomycin-C as adjuvant therapy remains controversial, although there is some rationale for its use in high-risk situations.

Sebaceous Gland Carcinoma of the Right Flank

Extraocular sebaceous gland carcinoma is a rare cutaneous malignancy which sometimes can grow rapidly. There is no proven effective treatment for metastatic disease, but the tumor can be successfully treated by surgery if diagnosed early. We report an 83-year-old gentleman with a rapidly growing sebaceous gland carcinoma of the right flank which was initially misdiagnosed as a vascular malformation. By the time he was referred, he had widespread metastatic disease and was a candidate for palliative radiation only.

Effects of Medpor® Sheet as Substitute for Tarsus in Eyelid Reconstruction

Purpose: To report a simple surgical technique for rebuilding the palpebral tarsal plate using a Medpor sheet. The formation of a palpebral tarsal plate is very important in the reconstruction of the eyelid. Transplantation of cartilaginous tissue is often necessary to create the palpebral tarsal plate. However obtaining enough cartilaginous tissue is difficult. Case summary: Eyelid reconstruction and surgical resection of each lesion was attempted on two patients clinically diagnosed with basal cell carcinoma and sebaceous gland carcinoma between August, 2006 and November, 2007. Reconstruction was performed using a modified Cutler-Beard method or the sebaceous gland carcinoma that occurred in the upper eyelid, and a modified Tenzel semicircular rotational flap procedure was used or the basal cell carcinoma that occurred in the lower eyelid. For the reconstruction of tarsus, 0.45 mm Medpor sheet was used. Complications, such as shortage of eyelid movement, dragging of eyelid or unstable eyelid margin, did not occur after the operations in either subject. In the case of the upper eyelid reconstruction, the eyelid became stiff at the early stage, but the condition improved after 6 months. Conclusions: The reconstruction of the palpebral tarsal plate using a Medpor sheet is considered an effective and safe technique for the reconstruction of an eyelid.

Primary sebaceous gland carcinoma of pinna

Sebaceous gland carcinoma is a rare cancer most commonly seen in the meibomian glands of the eyelid. It has predilection for periocular region and is rarely found in extra ocular sites. A case of sebaceous gland carcinoma over back of left pinna is reported.

Clustering of sebaceous gland carcinoma, papillary thyroid carcinoma and breast cancer in a woman as a new cancer susceptibility disorder: a case report

IntroductionMultiple distinct tumors arising in a single individual or within members of a family raise the suspicion of a genetic susceptibility disorder.Case presentationWe present the case of a 52-year-old Caucasian woman diagnosed with sebaceous gland carcinoma of the eyelid, followed several years later with subsequent diagnoses of breast cancer and papillary carcinoma of the thyroid. Although the patient was also exposed to radiation from a pipe used in the oil field industry, the constellation of neoplasms in this patient suggests the manifestation of a known hereditary susceptibility cancer syndrome. However, testing for the most likely candidates such as Muir-Torre and Cowden syndrome proved negative.ConclusionWe propose that our patient's clustering of neoplasms either represents a novel cancer susceptibility disorder, of which sebaceous gland carcinoma is a characteristic feature, or is a variant of the Muir-Torre syndrome.