Sebaceous Gland or Cell Carcinoma

Sebaceous Gland or Cell Carcinoma

Sebaceous gland carcinoma is a rare kind of malignancy of the skin. The function of the sebaceous glands is to produce natural skin oils. Although the sebaceous glands are present all throughout the body, sebaceous gland carcinoma mostly affects the ocular region, especially the upper eyelids. Outside the ocular region, the sebaceous gland carcinoma occurs in the head or neck, on the trunk, or in the genital area. It is a very aggressive form of cancer and spreads quickly to the surrounding tissue.

The most common site of origin of sebaceous gland carcinoma is the meibomian glands of the eyelids. Less frequently, it occurs in the other parts of the eyelid, the caruncle, the glands of Zeis, and in the eyebrow. Although sebaceous cell carcinoma appears benign, it is actually a lethal form of cancer. Its diagnosis is delayed at times due to its appearance. Distant metastasis affects 14–25% of cases and involves lymph node or hematogenous spread into liver, lungs, brain, and bones. The disease may recur and most of the recurrences appear within the first 4 years after treatment.

Epidemiology

The disease is rare and accounts for 0.5 % to 5% of eyelid carcinomas in the United States. The risk of disease increases with age and is most often diagnosed in women over 60 years of age. The incidence is much higher in China and other Asian countries.

Risks and causes of sebaceous gland carcinoma

Although the cause is not well understood, there are certain risk factors that can be associated with this disease. These are:

  • Benign tumors of the sebaceous glands
  • Exposure to radiation
  • Muir Torré syndrome (genetic condition)
  • Females are at a higher risk than males with a ratio of 1.51 to 1.0.

Symptoms

  • Persistent conjunctivitis, blepharoconjunctivitis or chronic/recurrent chalazion
  • Persistent irritating mass on the eyelid
  • Painless firm eyelid mass
  • Yellow colored nodule in the upper lid
  • Eyelash loss

Diagnosis

Diagnosis is based on the appearance of the mass and biopsy. Sebaceous gland carcinoma is often misdiagnosed.

Examination of the affected site by the doctor: The doctor checks the symptoms such as yellow nodule, eyelash loss that is not painful, etc. Since the condition mimics other benign conditions, other tests should be performed before coming to conclusion.

Biopsy: Cells or tissues removed from the affected tissue are examined under a microscope in the laboratory to check for signs of cancer. This is done by a pathologist in the laboratory. Persistent blepharoconjunctivitis or chalazion should be biopsied. A full thickness eyelid biopsy, combined with conjunctival biopsies in certain cases, is the appropriate approach.

Treatment for sebaceous gland carcinoma

Surgery: Surgical resection is the mainstay treatment for sebaceous gland carcinoma. The cancerous cells and a part of the region surrounding the cancerous site is removed. This reduces chances of recurrence. Adequate therapy requires wide excision of the lesion with a tumor free margin of at least 4 mm. Mohs micrographic surgery is recommended by many doctors since the rate of recurrence is very low after this surgery. Patients with local lymph node metastases can be cured by radical neck dissection in combination with partial parotidectomy. Patients must be followed up at short intervals postoperatively as the tumor has a fast growth potential.

Cryotherapy: Extreme cold is used in this surgery to destroy abnormal or diseased tissue. It can be used to treat patients of sebaceous gland carcinoma.

Radiotherapy: Radiotherapy should be avoided if possible because of significant side effects when treating the eye.

Chemotherapy: Chemotherapeutic agents like mitomycin-C can be used as adjuvant therapy to excision and cryotherapy in patients with sebaceous gland carcinoma (SGC) in high-risk locations.

Prognosis

Prognosis is poor with respect to most other malignant eyelid tumors with a mortality second only to malignant melanoma. It might be anticipated that the sooner appropriate treatment is instituted the better the prognosis. Numerous factors have been reported to influence the prognosis. The period of time that the tumor has been present definitely affects the outcome.

Tumors in excess of 10 mm are associated with a particularly poor outcome. Usually tumors of the upper lid have been associated with an adverse outcome relative to those affecting the lower lid. Carcinomas of the gland of Zeis are claimed to have the best prognosis. Histopathological features such as tumor differentiation, extent of infiltration, and intraepithelial spread have also been linked to prognosis.

References

  1. Wali UK, Al-Mujaini A. (2010) Sebaceous gland carcinoma of the eyelid.
  2. Oman J Ophthalmol. Sep;3(3):117-21.
  3. Kan LW, Leu YS, Tzen CY, Wu CH. (2010) Recurrent sebaceous gland carcinoma of eyelid previously diagnosed as basal cell carcinoma: case report.
  4. Am J Otolaryngol.
  5. Snow SN, Larson PO, Lucarelli MJ, Lemke BN, Madjar DD. (2002) Sebaceous carcinoma of the eyelids treated by mohs micrographic surgery: report of nine cases with review of the literature. Dermatol Surg.;28(7):623-31.
  6. Buitrago W, Joseph AK.(2008) Sebaceous carcinoma: the great masquerader: emgerging concepts in diagnosis and treatment. Dermatol Ther.;21(6):459-66.
  7. This article was originally published on September 3, 2012 and last revision and update was 9/4/2015.