Sebaceous carcinoma arises from the glands within the eyelids, caruncle or eyebrow. They are more commonly found on the upper eyelid and in middle-aged patients.

Sebaceous cell carcinoma is suspected due to evidence of eyelash loss and the formation of a yellow-nodule. This tumor can also present as a persistent (months) non-responsive redness of the eye or conjunctivitis. In these cases, a high index of suspicion for sebaceous cell carcinoma will lead to biopsy and the diagnosis. Once sebaceous carcinoma is suspected a biopsy is warranted. Before surgical biopsy, Dr. Shome informs the pathologist of this possible diagnosis so the specimen can be processed appropriately.

Symptoms
Sebaceous carcinomas are one of the rarest eye cancers and can look like a chalazion (stye – a swelling of the glands in the lid). Any conjunctivitis or chalazion that is not getting better after 3 months of observation, should be biopsied.

Diagnosis
Sebaceous carcinoma of the eyelid typically presents as a yellow-nodule in the upper lid. The tumor can cause eyelash loss and is not painful. This tumor can also present as a hypervascular conjunctival tumor and tends to spread along the conjunctival surface. The gold standard for diagnosis of sebaceous carcinoma is histopathologic evaluation on fresh tissue.

Treatments
Once the diagnosis is made, a metastatic survey (looking for other sites of cancer) is warranted. Sebaceous carcinoma can spread to regional lymph nodes (pre-auricular and cervical) as well as to lungs, brain, liver and bone. Published series have reported that the occurrence of metastatic disease was dependent on the size and location of the primary tumor and occurred in up to 27% of patients. Local tumor invasion of the lymph nodes, orbit or metastatic sites were associated with a poor prognosis for survival.

Treatment requires a COMPLETE resection. We use frozen section control to provide negative margins. Larger surgeries, cryodestruction and radiation may be required if resection is not possible. Exenteration (complete removal of the orbital contents is sometimes required for extensive or recurrent disease).