title: Sebaceous carcinoma of the eyelids: personal experience with 60 cases.
abstract: OBJECTIVE
  To describe clinical features, management, and prognosis of sebaceous carcinoma of the eyelid and adjacent structures.
  
  
  METHODS
  Single-center retrospective interventional case series.
  
  
  METHODS
  Sixty consecutive patients with sebaceous carcinoma of the eyelid and adjacent structures.
  
  
  METHODS
  Retrospective chart review and literature review.
  
  
  METHODS
  Presenting features, sites of origin, location, growth patterns, management, histopathologic findings, incidence of recurrence, metastasis, and mortality.
  
  
  RESULTS
  The median age at referral was 72 years, with 73% female. Four patients had prior irradiation to the area where the sebaceous carcinoma developed. Initial clinical diagnoses elsewhere were sebaceous carcinoma (32%), blepharoconjunctivitis (25%), chalazion (20%), basal cell carcinoma (13%), and squamous cell carcinoma (10%). Initial histopathologic diagnoses elsewhere were sebaceous carcinoma (50%), squamous cell carcinoma (18%), basal cell carcinoma (8%), and others or not available (24%). Initial anatomic sites were upper eyelid (75%), lower eyelid (22%), caruncle (2%), and bulbar conjunctiva (2% [1 case]). Orbital exenteration was necessary in 13%. Recently introduced techniques of posterior lamellar resection of the eyelids with reconstruction (7%) hopefully will decrease this incidence in the future. Pathologically, 47% showed intraepithelial (pagetoid) involvement, 27% of sebaceous carcinomas arose from the meibomian glands, and 18% arose from both meibomian and Zeis glands. Local recurrence developed in 18%, metastasis in 8%, and death from metastasis in 6%.
  
  
  CONCLUSIONS
  Despite the fact that the clinical features of sebaceous carcinoma have been widely reported, the diagnosis was suspected initially in only 32% of patients at first examination elsewhere and in only 50% at histopathologic examination elsewhere. Orbital exenteration was necessary in 13%, mostly patients seen in the earlier years of the study. With more recently employed treatment methods, there is a tendency to avoid exenteration and to use more conservative methods of treatment. It is hoped that these modern therapeutic approaches will result in fewer cases of recurrence and metastasis.
authors.affiliation: Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Shields
authors.forename: Hakan
authors.initials: H
authors.lastname: Demirci
authors.forename: Brian P
authors.initials: BP
authors.lastname: Marr
authors.forename: Ralph C
authors.initials: RC
authors.lastname: Eagle
authors.forename: Carol L
authors.initials: CL
authors.lastname: Shields
mesh_terms: D018266:Adenocarcinoma, Sebaceous / Q000473:pathology* / Q000556:secondary / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D017679:Cryotherapy; D005142:Eyelid Neoplasms / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D013508:Ophthalmologic Surgical Procedures; D017233:Orbit Evisceration; D011379:Prognosis; D012189:Retrospective Studies; D012626:Sebaceous Gland Neoplasms / Q000473:pathology* / Q000628:therapy; D021701:Sentinel Lymph Node Biopsy