Elsevier

Ophthalmology

Volume 111, Issue 12, December 2004, Pages 2151-2157
Ophthalmology

Original article
Sebaceous carcinoma of the eyelids: Personal experience with 60 cases

Presented as part 2 of the J. Howard Stokes Lecture, September 12, 2003; Florence, South Carolina (JAS). The Stokes Lecture part 1 was entitled “Changing Concepts in the Management of Circumscribed Choroidal Hemangioma” and will be published separately.
https://doi.org/10.1016/j.ophtha.2004.07.031Get rights and content

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.

Section snippets

Patients and methods

This study was approved by the Institutional Review Board at Wills Eye Hospital of Thomas Jefferson University. A detailed retrospective chart review was conducted on all patients with sebaceous carcinoma who were evaluated on the Oncology Service from February 1974 through June 2003. Data tabulated included general and demographic information, initial clinical and histopathologic diagnoses elsewhere, initial treatment elsewhere, initial symptoms and signs, visual acuities, anatomic sites of

Results

There were 60 patients with sebaceous carcinoma of the eyelid or adjacent tissues who were evaluated and managed at the Oncology Service. The 4 patients cited in Rundle et al,16 Margo and Grossniklaus,17 Lisman et al,18 and Shields et al,19 respectively, had their cases discussed in unusual case reports, before our decision to report this larger statistical series. Pertinent general data are shown in Table 1. There were no related specific systemic diseases, except for one patient who had a

Discussion

There have been only a few sizable reports of sebaceous carcinoma of the ocular adnexa.4, 5, 6, 7, 8, 12, 13, 14 Most of these larger series were derived from eye pathology laboratories that had limited clinical information and received specimens from a variety of physicians. The series reported here represents, to our knowledge, the largest clinical experience with patients managed by one team reported in the English language literature.

In agreement with prior reports, we found that sebaceous

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    Manuscript no. 240375.

    Supported by the Eye Tumor Research Foundation, Philadelphia, Pennsylvania; Retina Research Foundation, Houston, Texas (Award of Merit in Retina Research) (JAS); and Macula Foundation, New York, New York (CLS).

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