Author(s): Shields JA, Demirci H, Marr BP, Eagle RC Jr, Shields CL
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Abstract 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.
This article was published in Ophthalmology
and referenced in Journal of Clinical & Experimental Dermatology Research