Sebaceous Gland Carcinoma

First well-described by Allaire in 1891.

Approximately 75% of these tumors arise in the periocular region:

• In this region, sebaceous gland carcinoma represents 1.0% to 5.5% of eyelid malignancies:

  • Fourth after basal cell carcinoma, squamous cell carcinoma, and melanoma.

• Women tend to be affected somewhat more often than men:

  • With 57% to 77% of patients being women in several large series.

• Most patients present in their sixth or seventh decade of life:

  • Although the range is from early childhood through the nineties:

    • The youngest reported case arose in a 3-year-old child.

• An area rich in a variety of types of sebaceous glands:

  • Sebaceous gland carcinoma resembles normal sebaceous glands.

  • One may reasonably speculate that sebaceous gland carcinoma arises from mature sebaceous glands.

  • Histologic studies have suggested that periocular sebaceous gland carcinomas arise from the sebaceous glands in this region:

    • The following five types of sebaceous glands are seen in the periocular region:

      • Meibomian glands of the tarsal plate

      • Glands of Zeis of the cilia

      • Sebaceous glands of the eyebrows

      • Glands of the caruncle

      • Glands of the fine hair follicles of the eyelid surface

With a significant tendency for both local recurrence and distant metastasis:

• Reported local recurrence rates range from 9% to 36%, with larger series reporting recurrence rates in the 30% range:

  • Local recurrence tends to occur within 5 years.

• The rate of metastasis in extraocular and ocular sebaceous gland carcinoma is thought to be similar, occurring in 14% to 25% of cases:

  • First to the draining lymph nodes and then to distant sites:

    • Sites of distant metastasis include the:

      • Liver, lungs, bones, and brain

In addition, a varied histologic appearance may occur, and delayed diagnosis or misdiagnosis following a biopsy is not uncommon.

Instead, patients may receive multiple courses of incision and drainage for chalazion before a definitive biopsy is performed.

Only a few are associated with Muir-Torre syndrome:

• Although sebaceous adenoma and epithelioma are more specific markers for Muir-Torre syndrome:

  • An evaluation for this syndrome is advisable once sebaceous gland carcinoma is diagnosed:

    • In approximately 40% of cases, patients with Muir-Torre syndrome develop some type of sebaceous tumor before or concurrent with visceral malignancy.