Sebaceous carcinoma

Sebaceous cell carcinoma: The growth on this man’s lower eyelid is sebaceous carcinoma.

Sebaceous carcinoma: Overview

Also called sebaceous gland carcinoma, sebaceous gland adenocarcinoma, or meibomian gland carcinoma.

What is sebaceous carcinoma?

Sebaceous (suh-bey-shuhs) carcinoma (SC) is a rare skin cancer. It is considered an aggressive skin cancer because it can spread.

Found early and treated, treatment is often successful. It is helpful to know that:

Most SCs begin on an eyelid.
You may notice a painless, round, firmly implanted tumor on your upper or lower eyelid.
Sometimes you have to pull gently on your eyelid to see the tumor.

This cancer may begin elsewhere. It can develop in any sebaceous gland. We have sebaceous glands on most areas of our skin. SC tends to develop in and around the eyes because we have the greatest number of sebaceous glands in that area.

When this cancer begins in an eyelid, a dermatologist may refer to it as a meibomian (my-BOW-me-en) gland carcinoma. This is a unique type of sebaceous gland found in the eyelids.

Other growths develop on and around the eyelids. Most growths are benign (not cancer). If you notice a growth on your eyelid that remains despite treatment, you should make an appointment to see a dermatologist. The sooner this cancer is diagnosed and treated the better the outcome. If SC spreads, it can be deadly.

Image used with permission of the Journal of the American Academy of Dermatology: J Am Acad Dermatolog 1995: 33: 1-15.

References:
Martinelli PT, Cohen PR, Schulze KE et al. “Sebaceous Carcinoma.” In Nouri K. [editor]. Skin Cancer. United States. McGraw Hill Medical; 2008. p. 240-9.
Nelson BR, Hamlet KR, Gillard M et al. “Sebaceous carcinoma.” J Am Acad Dermatol 1995; 33: 1-15; quiz 6-8.
Spencer JM, Nossa R, Tse DT et al. “Sebaceous carcinoma of the eyelid treated with Mohs micrographic surgery.” J Am Acad Dermatol 2001;44:1004-9.

Two patients diagnosed with sebaceous carcinoma: What you see may be barely noticeable (C) or obvious (D).

Sebaceous carcinoma: Signs and symptoms

Signs and symptoms: On the eyelid

Many sebaceous carcinomas (SC) develop on an eyelid. When this rare skin cancer develops on an eyelid, the person may notice one or more the following:

Slowly growing, often yellowish lump on the eyelid that feels firm, deep, and painless.
Thickening of an eyelid, where lid meets lash.
Yellow or reddish crust on eyelid, where lid meets lash.
Growth on eyelid that looks like a pimple.
Growth on eyelid that bleeds.
Sore on eyelid that does not heal, or heals and reappears.

As the cancer progresses, it often looks like the person has pink eye. You may see growths on the upper and lower eyelid. The growths may open and ooze fluid. The eyelashes often fall out. As the cancer spreads, it can affect the eyesight.

Mistaken identity: Stye, chalazion, or pink eye

SC is rare. Other growths that develop on the eyelid are much more common. Sometimes, SC is mistaken for one of these eye conditions:

Stye: This is a common growth, which often looks like a pimple on the eyelid. Most styes feel tender when touched. SC tends to be painless. Without treatment, a stye can make blinking painful. The eyelid can swell, and the eyes may water.

Most styes clear with treatment, which usually involves applying a warm compress 4 to 6 times a day.

Chalazion: This common eye condition often causes an eyelid to swell. Most chalazions clear with treatment, which often requires the patient to apply warm compresses to the eye and use antibiotic eye drops.

Pink eye: Also called conjunctivitis, SC can look like pink eye that just won’t go away — even with treatment.

Signs and symptoms: Beyond the eyelid

Few people have been diagnosed with SC elsewhere on the body. When SC develops elsewhere, it usually appears on the head or neck. SC has also been diagnosed on the genitals, ear canal, breasts, and trunk (chest, back, abdomen, buttocks) of the body.

In these areas, SC may look like a slowly growing pink or yellowish lump. This lump may bleed. If you see any of the following for more than 2 weeks, you should immediately make an appointment to see a dermatologist:

New growth on your skin, eyelid, or inside your ear.
A mole or other spot that starts to change.
Any growth or spot that starts to bleed, grow, or change in any way.

Images provided courtesy of David Zloty, MD and reprinted with permission from the Journal of the American Academy of Dermatology (J Am Acad Dermatol 2009;61:549-60.)

References:
Eisen DB, Michael DJ, “Sebaceous lesions and their associated syndromes: Part I.” J Am Acad Dermatol 2009;61:549-60.
Harwood CA, McGregor JM, Swale VJ,et al.“High frequency and diversity of cutaneous appendageal tumors in organ transplant recipients.” J Am Acad Dermatol. 2003 48:401-8.
Nelson BR, Hamlet KR, Gillard M et al. “Sebaceous carcinoma.” J Am Acad Dermatol. 1995; 33:1-15; quiz 6-8.
Spencer JM, Nossa R, Tse DT et al. “Sebaceous carcinoma of the eyelid treated with Mohs micrographic surgery.” J Am Acad Dermatol. 2001;44:1004-9.
Torres JS,. Amorim AC, Hercules FM et al. “Giant extraocular sebaceous carcinoma: case report and a brief review of a literature.” Dermatol Online J. 2012 Nov 15;18(11):7.)

Sebaceous carcinoma: Who gets and causes

Who gets sebaceous carcinoma?

People diagnosed with this rare skin cancer tend to be between:

60 to 80 years of age.

Sebaceous carcinoma (SC) can begin earlier or later. According to research studies, SC has been diagnosed in a 3-year-old child and people in their 90s.

Other risk factors

Anything that increases your risk of getting a disease is a risk factor. For SC, age is a common risk factor. Other risk factors for SC are:

Weakened immune system: A weakened immune system greatly increases the risk for SC. The immune system may be weakened by:

Medicine taken to prevent the body from rejecting a transplanted organ.
Certain medical conditions, such as human immunodeficiency virus (HIV) or cancer.
Some medications used to treat psoriasis or arthritis.

Radiation treatments to the head or neck: People who received these radiation treatments as a child have been diagnosed with this rare skin cancer in their 60s and 70s. SC also develops in children who receive radiation treatments for retinoblastoma, a cancer that develops in the eye.

Asian heritage: SC on the eyelid may be more common in Asians. Some studies suggest this. Others studies have not found this to be true.

Muir-Torre syndrome: This is a rare medical condition. Many people do not know they have this condition until they are diagnosed with SC.

People who have Muir-Torre syndrome have a higher risk of developing some cancers. The risk is greatest for developing a type of colon cancer. Your doctor can talk with you about testing to find colon cancer in its earliest stage.

What causes sebaceous carcinoma?

SC is rare, so scientists still have much to learn, including what causes it. Because most SCs develop on the head and neck, the sun may play a role in causing this rare skin cancer.

If you notice a growth on your eyelid, it is important that you see a dermatologist for a diagnosis.

References:
Dasgupta et al. "A retrospective review of 1349 cases of sebaceous carcinoma." Cancer, 2009, SEER database study.
Harwood CA, McGregor JM, Swale VJ, et al. “High frequency and diversity of cutaneous appendageal tumors in organ transplant recipients.” J Am Acad Dermatol. 2003;48:401-8.
Omura NE, Collison DW, Perry AE, et al. “Sebaceous carcinoma in children.” J Am Acad Dermatol. 2002;47(6):950-3.
Spencer JM, Nossa R, Tse DT et al. “Sebaceous carcinoma of the eyelid treated with Mohs micrographic surgery.” J Am Acad Dermatol. 2001;44:1004-9.

Sebaceous carcinoma: Diagnosis and treatment

How do dermatologists diagnose sebaceous carcinoma?

If your dermatologist suspects that you have SC, your dermatologist needs some essential information. Be sure to tell your dermatologist if you have:

Muir-Torre syndrome (or if a family member has it).
A transplant organ.
Received radiation treatments, especially to your head or neck.
Taken a diuretic medicine (often used to treat high blood pressure and heart disease).

During the office visit, your dermatologist will:

Give you a thorough skin exam.
Feel your lymph nodes.

Your dermatologist may also perform a skin biopsy. A skin biopsy is the only way to diagnose skin cancer. Your dermatologist can safely do this during an office visit. To perform a skin biopsy, your dermatologist will remove either the entire growth or part of it.

What your dermatologist removes will be examined under a microscope. This magnified view allows a doctor to look for cancer cells.

If SC is suspected, you also will need:

A thorough physical exam.
A through eye exam.
Other medical tests.

Diagnosing SC can take time. The diagnosis is often based on many factors, including:

Your medical history.
The biopsy findings.
Discussions that a dermatologist has with the dermatopathologist (doctor who looks at the tumor under the microscope) and ophthalmologist (eye doctor).

How do doctors know if the cancer has spread?

Before creating a treatment plan for SC, your dermatologist or ophthalmologist wants to answer these questions:

Has the cancer spread to the lymph nodes?
Has the cancer spread to other parts of the body?

To find out whether the cancer has spread, you may need more medical tests, such as:

Fine needle aspiration biopsy: This test is used to obtain a sample from an internal organ, lymph node, or tissue beneath the skin. To perform this test, a surgeon (or other specially trained doctor) inserts a small, hollow needle. Once in the right place, the doctor uses the needle to remove a small sample. The sample will be checked for cancer cells.

Lymph node biopsy: The results from this procedure can tell doctors if the cancer has spread to a patient’s lymph nodes. During this surgery, one or more lymph node is removed. The removed lymph node(s) is checked for cancer cells.

Other medical tests: Other tests that can check for cancer include a colonoscopy, blood tests, and chest x-ray.

How is sebaceous carcinoma treated?

Most patients diagnosed with SC are treated with surgery. Two types of surgery are used to remove SC:

Excision: During this surgery, the surgeon removes the tumor and some surrounding tissue that looks healthy. This helps to remove cancer that may have traveled to an area that still looks healthy. An area can look healthy if it contains just a few cancer cells.

Mohs surgery: Because many SCs develop on an eyelid or other area with little extra skin, Mohs (pronounced "moes") surgery may be recommended. This specialized surgery is only used to treat skin cancer. This surgery allows the Mohs surgeon to remove less tissue yet remove the entire tumor.

During Mohs surgery, the Mohs surgeon cuts out the tumor plus a very small amount of healthy looking tissue surrounding the tumor. While the patient waits, the Mohs surgeon uses a microscope to look at what was removed. The surgeon is looking for cancer cells.

If the Mohs surgeon finds cancer cells at the edge of the removed tissue, the surgeon will remove another small amount of tissue and look at it under the microscope. This process continues until the surgeon no longer sees cancer cells along the edge of the removed tissue. Your Mohs surgeon may refer to this edge as the “margin.” When the Mohs surgeon no longer sees cancer cells along the edges, the surgeon may tell you that the “margins look clear.”

After the cancer surgery, some patients need reconstructive surgery. This surgery is often performed immediately after the cancer surgery.

Findings from a Mohs research study: One study followed 18 patients who had SC on an eyelid. All patients had Mohs surgery. Most (16 out of 18) patients were cancer-free after an average follow-up of 37 months.

Surgery to remove lymph nodes: When the cancer spreads to the lymph nodes, the patient may have surgery to remove the affected lymph nodes. Reports of patients surviving for many years after such surgery have been made.

Radiation treatments: Radiation is not the first choice for treating SC. This treatment may be an option for:

Easing a patient’s pain if the cancer has spread.
Treating patients who refuse or cannot withstand surgery.
Treating patients who have had surgery but may still have some cancer.

Cryotherapy: This treatment involves removing diseased skin by freezing it. More research is needed to find out whether this can be an effective treatment for SC.

Clinical trial: Some patients are encouraged to join a clinical trial. A clinical trial is a type of research study. The purpose of a clinical trial is to study how well a new treatment or a new way of treating a disease works. For some patients, joining a clinical trial may be the best treatment option.

What outcome (prognosis) can a patient with SC expect?

When found early and treated, the prognosis is good. It is important to keep in mind that SC is an aggressive cancer. This cancer can return after treatment. For these reasons, it is essential to keep all follow-up appointments with your doctors.

When found early and treated, SC has a high survival rate. The best way to find this cancer early is to return for check-ups. Your dermatologist will tell you how often you should return for check-ups. It is essential to keep all appointments.

References:
Martinelli PT, Cohen PR, Schulze KE et al. “Sebaceous Carcinoma.” In Nouri K. [editor]. Skin Cancer. United States. McGraw Hill Medical; 2008. p. 240-9.
Nelson BR, Hamlet KR, Gillard M et al. “Sebaceous carcinoma.” J Am Acad Dermatol 1995; 33: 1-15; quiz 6-8.
Spencer JM, Nossa R, Tse DT et al.“Sebaceous carcinoma of the eyelid treated with Mohs micrographic surgery.” J Am Acad Dermatol 2001;44:1004-9.
Torres JS,. Amorim AC, Hercules FM et al. “Giant extraocular sebaceous carcinoma: case report and a brief review of a literature.” Dermatol Online J. 2012 Nov 15;18(11):7.

Sebaceous carcinoma: Tips for managing

If you’ve been treated for sebaceous carcinoma (SC), dermatologists recommend the following:

Keep all follow-up appointments with your doctors. SC is an aggressive skin cancer. It can return after treatment.
Follow-up visits can help find this skin cancer in its earliest stage. The sooner the cancer is found and treated the better the outcome.
Perform skin self-exams as often as your dermatologist recommends. If you have received treatment for SC, it is essential that you learn how to perform a skin self-exam.Your dermatologist or someone in your dermatologist’s office can teach you exactly what you need to know, including how to examine your eyelids and certain lymph nodes.
Protect your skin from the sun. If you have had SC, sun protection can be helpful. The sun’s rays can weaken our immune system. Sun exposure also increases your risk of developing other types of skin cancer.
Ask your doctors what else you can do to improve your outcome. A patient’s needs can be unique. Be sure to ask your doctors what could help you.

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