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| OJHAS Vol. 12, Issue 2:
(Apr-Jun 2013) |
Case Report
Sebaceous Carcinoma of the Eyelid
Authors
Ajay Kamath R, Manjunath Kamath M, Gurudutt Kamath M, Madhurima Nayak A,
Department of Ophthalmology,
Kasturba Medical College, Mangalore.
Address for Correspondence
Dr. Ajay R Kamath,
1402, Westwind Apartments,
Collector’s Gate, Balmatta,
Mangalore - 575002,
Karanataka, India.
E-mail:
ajayrkamath@yahoo.com
Citation
Kamath AR, Kamath MM, Kamath GM, Nayak MA. Sebaceous Carcinoma of the Eyelid. Online J Health Allied Scs.
2013;12(2):16. Available at URL:
http://www.ojhas.org/issue46/2013-2-16.html
Open Access Archives
http://cogprints.org/view/subjects/OJHAS.html
http://openmed.nic.in/view/subjects/ojhas.html
Submitted: May 27,
2013; Accepted: Jul 5, 2013; Published: Aug 25, 2013 |
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Abstract: Sebaceous gland carcinoma of the eyelid is a very rare, slow growing tumor arising from the meibomian glands. In contrast to squamous cell carcinoma and basal cell carcinoma which arise frequently from the lower lid, sebaceous carcinoma arises from the upper lid where meibomian glands are more numerous. We present a case of sebaceous carcinoma in an elderly lady who presented with a slow growing tumor in the lateral third of the lower lid, without any lymp node metastasis. The tumor was treated by wide excision and the eyelid was reconstructed by Tenzel semilunar flap.
Key Words:
Sebaceous carcinoma; Lower lid malignancy; Reconstruction of lid; Tenzel semilunar flap |
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Introduction:
Carcinoma of Sebaceous glands is a highly malignant and potentially lethal tumor
that arises from the meibomian glands of the tarsal plate, from glands of Zeiss or sebaceous glands of caruncle,
periocular skin and eyebrow. It forms 1-5.5% of eyelid malignancies.(1) It usually presents in elderly women,
with a predilection for the upper lid as there are more number ofmeibomian glands than in the lower lid.(1) The
clinical suspicion of Sebaceous gland carcinoma (SGC) is quite difficult as it may simulate a benign tumor or
blepharoconjunctivits. Its ability to cause skip lesions and intraepithelial spread gives the tumor a special place
among other lid tumors.
Case report:
A 52 years old woman presented with a slow growing mass in the left lower lid,
which had gradually progressed over the last six months. Ocular examination revealed an ulcerative growth over the outer
third of the left lower eye lid margin, measuring 1.5cm involving marginal conjunctiva. It showed yellowish discoloration over
the ulcerated surface and lashes were absent [Fig 1]. There was no corneal or conjunctival involvement. There was no local
lymphadenopathy. She underwent a wide excision of the tumor under local infiltration. A full thickness excision with 5mm of
clinically normal tissue was performed. A semilunar flap was raised temporal with concavity inferiorly and edges were sutured.
The excised tissue was sent for histopathological examination. Sections showedtumor arising from the epidermis and infiltrating
dermis in nests of folliculocentric pattern. The cells had vacuolated cytoplasm and moderately pleomorphic hyperchromatic
nuclei suggestive of sebaceous carcinoma [Fig 2]. She was followed up. One month later, the flap was taken up well and
there was no recurrence.
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Fig 1: Left lower eye lid mass lesion |
Fig 2: Vacuolated cytoplasm and moderately pleomorphic hyperchromatic nuclei suggestive of sebaceous carcinoma |
Discussion:
Meibomian glands are modified sebaceous glands embedded within Tarsal plates. They
are about 25 in number in the upper lid and 20 in the lower lid. Sebaceous carcinomas are second most common malignancies
of the eyelid(2) and arise from meibomian glands. These tumors often masquerade as benign eyelid diseases like
chalazia, chronic blepharitis, basal cell or squamous cell carcinoma, ocular cicatricialpemphigoid or superior limbic
keratoconjunctivitis. It causes effacement of the meibomian gland orifices with destruction of follicles of cilia and loss
of lashes.
In general, there are two pathological presentations of sebaceous carcinoma- nodular
and spreading. More than 50% cases may present as a pseudochalazion or chronic blepharoconjunctivitis.(3-5) The
nodular variant is usually a hard, immobile nodule in the upper tarsal plate. Any chalazion which recurs more than three
times after incision and curettage should be biopsied to rule out sebaceous carcinoma.(6) The tumor can also
present as a spreading variety with diffuse infiltration of the skin.(7) Pagetoid spread refers to extension
of tumor into the epithelium which may simulate an inflammatory condition. Map biopsies are helpful in detecting such
variants.
Treatment of sebaceous carcinoma is primarily surgical. It may range from excision to
exenteration. They have a 30% chance of recurring after excision.(8) Wide excision is mandatory for adequate
treatment. Good outcome has been reported with 4mm surgical margins.(9) Mohs micrographic surgery
is a common and effective method of treatment. Reconstruction depends on the amount of tissue to be excised. Small
defects can be reconstructed by direct closure. Larger tumors require lid reconstructions using tissue flaps like
Tenzel semilunar flap and Musterdemucocutaneous flap. Other modalities of treatment are Mitomycin C, Cryotherapy
and Radiotherapy.(6) Lymph node metastasis requires radical neck dissection.
References:
- Ni C, Kou PK. Meibomian gland carcinoma: A clinico-pathological study of 156 cases with long-period follow up of 100 cases.
Jpn J Ophthalmol. 1979;23:388–401
- McLean IW, Jackobiec FA, Zimmerman LE, Burnier MM. Tumours of the Eye and Ocular Adnexa, Vol 3. Maryland Armed Forces
Institute of Pathology: Washington, 1993. pp 28–35
- Foster CS, Allansmith MR. Chronic unilateral blepharoconjunctivitis caused by sebaceous carcinoma. Am J Ophthalmol.
1978;86:218–220.
- Sweebe EC, Cogan DG. Adenocarcinoma of the meibomian gland; a pseudochalazion entity. Arch Ophthalmol 1959;61:282–290.
- Condon GP, Brownstein S, Codère F. Sebaceous carcinoma of the eyelid masquerading as superior limbic keratoconjunctivits.
Arch Ophthalmol. 1985;103:1525–1529.
- Wali UK, Mujaini A. Sebaceous gland carcinoma of the eyelid. Oman J Ophthalmol. 2010 Sep-Dec;3(3):117–121
- Zurcher M, Hinstchich CR, Garner A, Bunce C, Collin JR. Sebaceous carcinoma of the eyelid: A clinicopathological study.
Br J Ophthalmol. 1998;82:1049–1055.
- Epstein GA, Putterman AM. Sebaceous adenocarcinoma of the eyelid. Ophthalmic Surg. 1983;14:935–940
- Muqit MMK, Roberts F, LeeWR, Kemp E. Improved survival rates in sebaceous carcinoma of the eyelid. Eye. 2004;18:49–53.
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