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Dermatologic Manifestations of Sebaceous Carcinoma Treatment & Management

  • Author: Wesley Wu, MD; Chief Editor: Dirk M Elston, MD  more...
Updated: Apr 15, 2016

Medical Care

Sebaceous gland carcinoma is an aggressive tumor with a tendency for both local recurrence and metastasis. Delay in diagnosis may contribute to the poor outcome in this tumor; therefore, a high degree of suspicion when eyelid lesions occur and a willingness to perform a biopsy will most likely contribute to a better prognosis for patients with this tumor. Radiation therapy has traditionally been considered palliative but not curative. Chemotherapy has also been used in aggressive cases with mixed results and requires further study.

In a small series of 6 patients, all 6 experienced a relapse 2 months to 2 years following radiation therapy, but they remained tumor-free following subsequent surgery.[79]

Rao et al reported a mortality rate of 78% in patients treated primarily with radiation therapy, in contrast to a rate of 7% for those treated with wide excision[17] ; however, one case report describes 2 patients who refused surgery who were successfully treated with radiation therapy[80] and another case series describes 2 patients who underwent radiation therapy as well, with no recurrence after 27 and 36 months, respectively.[33]

Drawing conclusions from only a few cases is premature, but the possibility exists that advancements in radiation technology and technique may make this a viable therapeutic option in the future.

While the significance of pagetoid spread is debated, most authors agree treatment of this epithelioid spread is warranted. It has been suggested, but not studied, that topical chemotherapy to the involved conjunctivae following surgical excision of the invasive tumor may be beneficial.[33, 35]

Systemic chemotherapy may be an option for sebaceous carcinoma refractory to surgical excision and radiotherapy. Case studies have reported variable results with use of 5-fluorouracil, cisplatin, docetaxel, and capecitabine for aggressive tumors. These reports have suggested its potential use as a preoperative neoadjuvant therapy.[81, 82, 83, 84]


Surgical Care

Sebaceous gland carcinoma remains a dangerous tumor and produces significant morbidity and mortality. Heightened awareness by the clinician and early biopsy may impact management of this rare tumor. Therapeutically, cryosurgery and surgical excision have been used for sebaceous carcinoma.[35]

Cryotherapy has been useful for a variety of cutaneous tumors and holds the theoretic advantage of treating large areas of conjunctivae if pagetoid spread is present. Long-term studies evaluating the use of cryosurgery for sebaceous gland carcinoma with pagetoid spread need to be performed.

Surgery has been and remains the primary treatment modality for sebaceous gland carcinoma. When orbital involvement is documented, therapy has traditionally been orbital exenteration.[71] Without orbital involvement, surgical therapy typically involves excision of the visible tumor plus 5-6 mm of healthy-appearing tissue in all directions, followed by either frozen section or permanent section for histologic analysis.[85] This approach has not been completely satisfying, because local recurrence occurs in approximately one third of patients,[6] with a 5-year mortality rate reported to range from 18-30%.[85]

The use of the fresh-tissue Mohs technique has been successful in a number of case reports. Spencer et al treated 18 patients with periocular sebaceous gland carcinoma using the Mohs technique, with an average follow-up period of 37 months. The recurrence rate was 11.1%, one of which also developed metastatic disease to the parotid lymph nodes.[85] Similarly, a retrospective review of 49 cases of sebaceous carcinoma treated by the Mohs technique revealed a local recurrence rate of 12% (6 of 49) and a metastatic rate of 8%.[86] In a retrospective study at the Mayo clinic comparing wide local excision with the Mohs technique in 52 patients with 70 sebaceous carcinomas, the Mohs group had a recurrence rate of 1 per 35 at 6 years postoperatively and 1 per 24 in the wide local excision group (median margin 1 cm) at 4 months after surgery.[87] Although recurrence rates may be attributed to discontiguous growth, Mohs micrographic surgery seems to offer a reduced recurrence rate compared with standard excision.

The treatment of tumors with pagetoid spread remains controversial. Some authorities have suggested that complete excision of involved epithelia is necessary, while others have suggested only frank invasive tumor needs to be treated, after which only careful clinical observation of the involved epithelia is warranted. Given the aggressive nature of this tumor, treating pagetoid spread as direct tumor extension and continuing surgical excision until all margins are clear, including clear of pagetoid spread, is wise.[88]

One retrospective study from England using “slow Mohs,” or delayed reconstruction after complete excision with paraffin section control for 17 patients, reported improved evaluation of pagetoid spread with paraffin-embedded sections and local recurrence of 18% and mortality of 12% after an average follow-up of 5 years.[89]

Future larger series are needed to better delineate the true significance of pagetoid spread.

Given that lymph node involvement may be seen in 15-21% of cases, prophylactic lymph node excision or sentinel lymph node biopsy may be considered in conjunction with surgical excision of sebaceous carcinoma. However, neither of these options has been recommended by a sufficient body of evidence.[90, 91]

Based on the Surveillance, Epidemiology, and End Results Program (SEER) reported rates of regional and distant metastasis for ocular sebaceous carcinoma (4.4%) and extraocular head and neck sebaceous carcinoma (0.9%),[92] Chang et al suggest sentinel lymph node biopsy for ocular sites and routine reginal lymph node surveillance for extraocular head and neck sites.[65] In addition, the authors in a retrospective study of 50 patients with ocular sebaceous carcinoma concluded that a sentinel lymph node biopsy or strict regional lymph node surveillance may be appropriate for ocular sebaceous carcinomas greater than 10 mm.[44]

Parotidectomy has also been reported in cases of sebaceous carcinoma with regional lymphadenopathy or metastasis.[10] Given the potential for metastasis to the parotid gland, further evaluation is warranted, particularly with an upper eyelid sebaceous carcinoma.[7, 33, 48]



Referral to an internist and gastroenterologist is warranted in patients diagnosed with sebaceous carcinoma in order to evaluate for the presence of internal (internist) and bowel (gastroenterologist) lesions associated with Muir-Torre syndrome. A geneticist is also recommended for further workup of syndromic associations.

Contributor Information and Disclosures

Wesley Wu, MD Resident Physician, Department of Dermatology, Baylor College of Medicine

Wesley Wu, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, Society for Pediatric Dermatology

Disclosure: Nothing to disclose.


Mohsin R Mir, MD Director, High Risk Skin Cancer Clinic, Assistant Professor, Mohs Surgery, Laser and Cosmetic Surgery, Department of Dermatology, Baylor College of Medicine

Mohsin R Mir, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

John G Albertini, MD Private Practice, The Skin Surgery Center; Clinical Associate Professor (Volunteer), Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine; President-Elect, American College of Mohs Surgery

John G Albertini, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery

Disclosure: Received grant/research funds from Genentech for investigator.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Kelly M Cordoro, MD Assistant Professor of Clinical Dermatology and Pediatrics, Department of Dermatology, University of California, San Francisco School of Medicine

Kelly M Cordoro, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Medical Society of Virginia, Society for Pediatric Dermatology, Women's Dermatologic Society, Association of Professors of Dermatology, National Psoriasis Foundation, Dermatology Foundation

Disclosure: Nothing to disclose.


Amy Lynn Basile, DO, MPH Sun Coast Hospital/Largo Medical Center, Largo, Florida

Amy Lynn Basile, DO, MPH is a member of the following medical societies: American Medical Association, American Osteopathic Association, and American Osteopathic College of Dermatology

Disclosure: Nothing to disclose.

James M Spencer, MD Professor of Clinical Dermatology, Mount Sinai School of Medicine, New York; Private Practice, Spencer Dermatology, St Petersburg, Florida

James M Spencer, MD is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Dermatological Association, American Medical Association, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, and International Society for Dermatologic Surgery

Disclosure: Graceway Pharmaceutical Honoraria Speaking and teaching; Sanofi Aventis Honoraria Consulting; Medicis Grant/research funds Independent contractor; Peplin Grant/research funds Independent contractor; Leo Pharmicuticals Honoraria Board membership

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Irregular lobules and sheets of atypical sebaceous cells (20x magnification).
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