AUSTIN, TEX. Mohs surgery seems to be effective for primary sebaceous cell carcinoma when there is an absence of orbital extension, according to a retrospective case study.
Sebaceous cell carcinoma of the eyelid is extremely rare, but not uncommon, representing up to 5% of all eyelid tumors, Dr. Humza Ilyas of the University of Wisconsin, Madison, said at the annual meeting of the American College of Mohs Surgery. Dr. Ilyas presented a series of 16 cases that were seen at a single clinic from 1987 to 2008.
A major issue with these tumors is that they are frequently misdiagnosed histopathologically and clinically, said Dr. Ilyas. That causes a delay in diagnosis, so "it's important to maintain a high index of suspicion," he said. Patients who have the tumors typically do not do that well. Primary sebaceous cell carcinoma is complicated by recurrence, and it can be multicentric or demonstrate pagetoid spread.
In this case series, nine tumors (56%) were on the upper lid and seven (44%) were on the lower lid. The patients' mean age was 72 years, with a range of 5190. Mean time from symptom onset to diagnosis was 8 months (range, 5 weeks to 2 years).
One patient had orbital extension, and exenteration was performed. All other patients had Mohs surgery (15), with a mean of 3.5 layers. One Mohs patient was lost to follow-up. Post-op follow-up ranged from 7 months to 14 years, with a mean duration of 4.5 years.
One (7%) of the 14 Mohs patients developed a local recurrence 1.5 years after surgery; that patient had exenteration as treatment and had no further evidence of disease 12 years later. Twelve of the 14 (86%) had no evidence of local recurrence.
Of the 14 who had Mohs, 6 (43%) had histologic evidence of pagetoid spread. There were no deaths attributable to the sebaceous cell carcinoma.
Dr. Ilyas said that although this was a small study, Mohs appears to be the most effective option for tumors with pagetoid spread. The outcomes were comparable to published series in the literature with conventional wide excision with frozen or paraffin margin controls, he said. There may be instances where adjunctive radiation or topical chemotherapy may be helpful.
Dr. Ilyas reported no disclosures.