Sebaceous carcinoma




Called sebaceous gland carcinoma, sebacious cell carcinoma, sebaceous gland adenocarcinoma, or meibomian gland carcinoma.



Factors possibly associated with increase the risk of these tumours:



Underlying Muir-Torre or Lynch syndrome



Previous radiation therapy to the area for a variety of benign and malignant 


conditions, such as retinoblastoma



History of oral thiazide diuretic use



Mutations to the tumour suppressor gene p53






 A rare skin cancer. 



Considered an aggressive skin cancer.



Sebaceous carcinoma most commonly develops from the meibomian glands which are located mostly in the upper but also in the lower eyelids. 



Clinical features of ocular sebaceous carcinoma include:



Small, erythematous or yellowish, firm, deep-seated, slowly enlarging nodule on the upper eyelid.



Lesions occur on the upper eyelid 2–3 times more commonly than on the lower eyelid.



The lesion is often mistaken for chalazion.



It may spread onto the conjunctiva, where it can be mistaken for keratoconjunctivitis or blepharoconjunctivitis.



In advanced cases, the spread of the lesion may lead to both upper and lower lid lesions and cause loss of eyelashes 


, ulceration and distorted vision.



Found early and treated, treatment is often successful. 



Most cases  begin on an eyelid.



Presents as a painless, round, firmly implanted tumor.



It can develop in any sebaceous gland.



It tends to develop in and around the eyes because we have the greatest number of sebaceous glands in that area.



Two types of surgery are used to remove SC:






Mohs surgery:



Some patients need reconstructive surgery.



Approximately, 30% of sebaceous carcinomas recur after resection.



In a study of 18 patients who had SC on an eyelid: All patients had Mohs surgery, with 16 out of 18 cancer-free after an average follow-up of 37 months.



When the cancer spreads to the lymph nodes, lymphadenectomy may result in long-term survival.



Radiation treatment as an option;



Pain palliation.



In patients who refuse or cannot withstand surgery.



Treating patients who have had surgery but may still have some cancer.



When found early and treated, SC has a high survival rate. 



Extraocular sebaceous carcinoma accounts for about 25% of sebaceous carcinomas. 



These tumours mostly occur around the head and the neck. 



Other sites include the genitals, ear canal, breasts, trunk and oral cavity.



Extraocular lesions are non-specific; they typically appear as a pink to a yellow-red nodule of varying sizes.



The diagnosis may be suspected clinically, as ermoscopy may reveal typical irregular yellowish lobules and irregular linear blood vessels.



Immunohistochemistry stains may be used to determine the likelihood of an underlying genetic syndrome.



The diagnosis of ocular sebaceous carcinoma is often delayed by months to years,



The mean delay from disease onset to diagnosis ranges from 1–3 years.



Numerous other inflammatory conditions, autoimmune diseases, infectious processes and other tumors may mimic the condition.



Conditions/diseases that mimic ocular sebaceous carcinoma: 












Blepharoconjunctivitis or blepharitis



Papillary conjunctivitis



Pyogenic granuloma / reactive haemangioma



Ocular cicatricial pemphigoid






Granulomatous inflammation from syphilis or tuberculosis 






Central retinal artery occlusion causing proptosis



Torre-Muir syndrome



Basal cell carcinoma



Squamous cell carcinoma



Cutaneous horn



Conjunctival carcinoma



Merkel cell carcinoma



Benign hair follicle tumors such as sebaceous hyperplasia and sebaceous adenoma. 



Benign sweat gland lesions



Metastatic tumors



The overall mortality rate is 5–10%.



Factors for a poorer prognosis include delay in diagnosis of greater than 6 months, tumor diameter greater than 1 cm, and both upper and lower eyelid involvement. 



Radiation therapy should only be used in patients unable or willing to undergo surgery.






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