Sebaceous carcinoma of the eyelids: personal experience with 60 cases

Jerry A Shields, Hakan Demirci, Brian P Marr, Ralph C Eagle, Carol L Shields
Ophthalmology 2004, 111 (12): 2151-7

OBJECTIVE: To describe clinical features, management, and prognosis of sebaceous carcinoma of the eyelid and adjacent structures.

DESIGN: Single-center retrospective interventional case series.

PARTICIPANTS: Sixty consecutive patients with sebaceous carcinoma of the eyelid and adjacent structures.

METHODS: Retrospective chart review and literature review.

MAIN OUTCOME MEASURES: Presenting features, sites of origin, location, growth patterns, management, histopathologic findings, incidence of recurrence, metastasis, and mortality.

RESULTS: The median age at referral was 72 years, with 73% female. Four patients had prior irradiation to the area where the sebaceous carcinoma developed. Initial clinical diagnoses elsewhere were sebaceous carcinoma (32%), blepharoconjunctivitis (25%), chalazion (20%), basal cell carcinoma (13%), and squamous cell carcinoma (10%). Initial histopathologic diagnoses elsewhere were sebaceous carcinoma (50%), squamous cell carcinoma (18%), basal cell carcinoma (8%), and others or not available (24%). Initial anatomic sites were upper eyelid (75%), lower eyelid (22%), caruncle (2%), and bulbar conjunctiva (2% [1 case]). Orbital exenteration was necessary in 13%. Recently introduced techniques of posterior lamellar resection of the eyelids with reconstruction (7%) hopefully will decrease this incidence in the future. Pathologically, 47% showed intraepithelial (pagetoid) involvement, 27% of sebaceous carcinomas arose from the meibomian glands, and 18% arose from both meibomian and Zeis glands. Local recurrence developed in 18%, metastasis in 8%, and death from metastasis in 6%.

CONCLUSIONS: Despite the fact that the clinical features of sebaceous carcinoma have been widely reported, the diagnosis was suspected initially in only 32% of patients at first examination elsewhere and in only 50% at histopathologic examination elsewhere. Orbital exenteration was necessary in 13%, mostly patients seen in the earlier years of the study. With more recently employed treatment methods, there is a tendency to avoid exenteration and to use more conservative methods of treatment. It is hoped that these modern therapeutic approaches will result in fewer cases of recurrence and metastasis.

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