Elsevier

Ophthalmology

Volume 108, Issue 10, October 2001, Pages 1877-1883
Ophthalmology

Outcome of patients with periocular sebaceous gland carcinoma with and without conjunctival intraepithelial invasionHistorical image

https://doi.org/10.1016/S0161-6420(01)00719-9Get rights and content

Abstract

Purpose

To evaluate the clinical findings, histopathologic features, methods of management, and outcomes in 25 patients with eyelid sebaceous gland carcinoma with and without conjunctival intraepithelial (pagetoid) invasion.

Participants

Twenty-five patients with sebaceous gland carcinoma of the periocular region.

Design

Retrospective, observational case series.

Methods

The patients were divided into two groups: group A included those with sebaceous gland carcinoma with conjunctival intraepithelial (pagetoid) invasion, and group B included those with sebaceous gland carcinoma without conjunctival intraepithelial invasion. The demographic, clinical, and histopathologic features of sebaceous gland carcinoma were reviewed separately for each group. Ocular management results and systemic prognosis were reviewed.

Results

Of the 25 patients, 18 (72%) were females and 7 (28%) were males. The mean age at diagnosis was 65 years (range, 17–90 years). There were 11 patients (44%) in group A, and 14 (56%) in group B. The most common symptom in group A was ocular irritation (45%), and in group B the most common symptom was eyelid lump (86%). The most common sign in group A was diffuse eyelid thickening (72%), and in group B the most common sign was a distinct eyelid mass (43%). Six patients (55%) in group A, compared with one patient (7%) in group B, had both upper and lower eyelid involvement. The most frequent location of tumor epicenter was the outer third of the eyelid in both groups: 37% in group A and 57% in group B. Histopathologic origin of tumor was multicentric in four patients (36%) of group A and six patients (50%) of group B. Before referral, local recurrence had been found in 4 of 12 patients (33%) who underwent surgical treatment elsewhere. After referral, local recurrence was detected in 1 patient (9%) in group A and in 2 patients (14%) in group B. Orbital exenteration was necessary in 4 patients (36%) in group A and in one patient (7%) in group B. Tumor-related metastases occurred in two patients (18%) in group A and in two patients (14%) in group B.

Conclusions

Sebaceous gland carcinoma with conjunctival intraepithelial (pagetoid) invasion has different clinical features compared with that without pagetoid invasion. Conjunctival intraepithelial (pagetoid) invasion carries a higher risk for orbital exenteration, but the risk of tumor-related metastases is similar in both groups.

Section snippets

Patients and methods

A computerized search was made of the medical records of all patients diagnosed with sebaceous gland carcinoma of the eyelids at the Oncology Service of Wills Eye Hospital, Philadelphia, Pennsylvania, between August 1979 and April 2000. There were 25 patients (25 eyes) identified who had sebaceous gland carcinoma of the eyelid, and all were included in this analysis.

The data from previous evaluations elsewhere were collected, including patient age at initial presentation (years), initial

Results

The demographic features of the 25 patients with sebaceous gland carcinoma are shown in Table 1. The mean age of the patients was 65 years (range, 17–90 years). There were 18 women (72%) and 7 men (28%), all of whom were white. No patients showed systemic Muir-Torre syndrome.12 Three patients (12%) had received prior facial external beam radiation therapy, one for pubertal acne and two for retinoblastoma. The median age at presentation in group A was 73 years (range, 33–87 years), and in group

Discussion

Sebaceous gland carcinoma displays intraepithelial conjunctival (pagetoid) invasion in 40% to 80% of cases.6, 7, 13 In our series, 11 patients (46%) had conjunctival intraepithelial invasion (group A). We found the demographic features of sebaceous gland carcinoma in our series to be comparable with previous reports. This tumor has been reported to show more prevalence in females with a female-to-male ratio of approximately 1.7 to 2.87, 10 and an average age at presentation of 60 to 69 years.2,

References (24)

  • J.A Shields et al.

    Meibomian gland carcinoma presenting as a lacrimal gland tumor

    Arch Ophthalmol

    (1974)
  • N.A Rao et al.

    Sebaceous carcinoma of eyelid and carunclecorrelation of clinicopathologic features with prognosis

  • Cited by (114)

    • Adnexal neoplasms of the eye

      2024, Clinics in Dermatology
    • Sebaceous carcinoma: evidence-based clinical practice guidelines

      2019, The Lancet Oncology
      Citation Excerpt :

      Pagetoid spread was present in 208 (24%) of 870 cases. Pagetoid tumours were more likely than non-pagetoid tumours to be poorly differentiated,14 recurrent,15 and require orbital exenteration;15,16 pagetoid tumours were also at higher risk for metastasis.17,18 For extraocular sebaceous carcinoma, positive immunohistochemical markers, as reported in a total of 38 studies, included nuclear factor XIIIa (AC-1A1), EMA (positive in squamous cell carcinoma), cytokeratin AE1 and AE3 (positive in squamous cell carcinoma), androgen receptor, adipophilin, and perilipin.

    View all citing articles on Scopus

    Supported by Department of Ophthalmology, Chang Gung Memorial Hospital, Taipei, Taiwan (ANC); Magrabi Eye Hospital, Cairo, Egypt (HK); Macula Foundation, New York, New York (CLS); Paul Kayser International Award of Merit in Retina Research, Houston, Texas (JAS); and the Eye Tumor Research Foundation, Philadelphia, Pennsylvania (CLS).

    View full text