title: Conjunctival epithelial involvement by eyelid sebaceous carcinoma. The 2003 J. Howard Stokes lecture.
abstract: OBJECTIVE
  To determine incidence and distribution of conjunctival epithelial involvement by eyelid sebaceous carcinoma and to make recommendations regarding its management.
  
  
  METHODS
  The medical records were reviewed retrospectively on patients with histopathologically confirmed sebaceous carcinoma of the eyelids managed at the Oncology Service at Wills Eye Hospital. Those tumors with involvement of the conjunctival epithelium were identified and selected for further study. The incidence and distribution of epithelial involvement was determined, based on histopathology of resected tumors and map biopsies. The incidence of metastasis and tumor-related mortality was determined. Based on these findings and personal surgical experience, recommendations are made regarding management of eyelid sebaceous carcinoma with involvement of the conjunctival epithelium.
  
  
  RESULTS
  Of 60 patients with sebaceous carcinoma, epithelial involvement of the conjunctiva was identified in 28 (47%). Of the 28 cases, the neoplasm affected the following sites: superior tarsal and fornical conjunctiva in 28 (100%), inferior tarsal conjunctiva in 19 (68%), inferior fornical conjunctiva in 18 (64%), superior bulbar conjunctiva in 19 (68%), and inferior bulbar conjunctiva in 16 (57%). The caruncle was involved in 15 (54%) and the cornea in 11 (39%). Metastasis occurred in 3 of the 28 cases (11%). Map biopsies, combined with cryotherapy, topical chemotherapy, local surgical resection, and orbital exenteration, were used to achieve local control.
  
  
  CONCLUSIONS
  Eyelid sebaceous carcinoma was found to exhibit epithelial involvement of the conjunctiva in 47% of cases, predominantly in the superior tarsal and fornical conjunctiva and less often in the inferior tarsal conjunctiva, caruncle, and cornea. Treatment of this condition is challenging, and map biopsy, cryotherapy, topical chemotherapy, and newer surgical methods are being used more often by our group.
authors.affiliation: Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. jas.cls@comcast.net
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: Mary
authors.initials: M
authors.lastname: Stefanyszyn
authors.forename: Carol L
authors.initials: CL
authors.lastname: Shields
mesh_terms: D018266:Adenocarcinoma, Sebaceous / Q000473:pathology* / Q000601:surgery; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002278:Carcinoma in Situ / Q000473:pathology* / Q000601:surgery; D003131:Combined Modality Therapy; D003230:Conjunctival Neoplasms / Q000473:pathology* / Q000601:surgery; D017679:Cryotherapy; D005142:Eyelid Neoplasms / Q000473:pathology* / Q000601:surgery; D006801:Humans; D015994:Incidence; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies; D012626:Sebaceous Gland Neoplasms / Q000473:pathology* / Q000601:surgery
chemical_list: D000970:Antineoplastic Agents