Dermatologic Manifestations of Sebaceous Carcinoma Clinical Presentation

Updated: Mar 22, 2019
  • Author: Wesley Wu, MD; Chief Editor: Dirk M Elston, MD  more...
  • Print
Presentation

History

The presentation of sebaceous gland carcinoma is often nonspecific, and a noncancerous condition of the periocular area may be mistakenly assumed. A biopsy-confirmed diagnosis is typically delayed for months, and even years. [10, 46]

Most often, a painless nodule develops on the eyelid, and the patient receives treatment for the far more common benign chalazion. [6, 8, 12]

Next:

Physical Examination

Sebaceous gland carcinoma has a varied clinical presentation that often results in delayed diagnosis. Tumors of the upper lid are 2-3 times more common than lesions of the lower lid. [6, 18, 45, 47] The most common presentation is a firm, slowly enlarging, yellow to red-brown plaque or nodule of the upper eyelid, owing to its greater density of meibomian glands, and is often mistaken for a chalazion. [6, 8, 12] The surface of the lesion may be friable, crusted, or ulcerated.

In a variety of series, the delay in diagnosis following presentation ranges from 1-5 years. [10, 46] Loss of cilia is a clinical clue that the lesion is malignant. [47]

One study reported 7 of 31 patients presented with a characteristic “tigroid” pattern of the conjunctiva, described as yellow streaks (lipid material from the meibomian glands) within an area of papillary hypertrophy. [10] Clinical presentation can mimic keratoconjunctivitis, [8, 12] squamous cell carcinoma, basal cell carcinoma, cutaneous horn, [58] sarcoidosis, ocular pemphigoid, and a variety of benign and malignant ocular tumors. [6, 10]

Extraocular sebaceous gland carcinoma represents 75% of reported tumors, which are more common in men. [44] The head and the neck are where most extraocular sebaceous gland carcinomas occur, with the parotid gland alone representing 30% of cases. [59] Rare reports describe tumors arising in virtually every area of the body. Unusual anatomical locations reported in association with sebaceous carcinoma include the genitalia, [3, 6] the parotid gland, [60] the ear canal, [61] the breast, [62, 63] and the intraoral cavity. [2]

An Australian report characterized the dermatoscopic features of extraocular sebaceous carcinoma to have polymorphous vessels, asymmetry, and ulcerated areas with a variable yellow background. [64] The vasculature may be variable given different array of microvessels between the epidermis and tumor. Yellowish structures represent sebaceous differentiation. A Japanese publication suggested also dermatoscopically examining whitish pink areas that represented telangiectases, inflammatory infiltrate, and fibrosis. [65] An Indian study also focused on irregular abruptly ending borders and various colors in a single dermoscopic field indicating a high suspicion for extraocular sebaceous carcinoma. [66] The findings may be relatively nonspecific, but they should raise suspicion for the diagnosis.

Pagetoid intraepithelial spread may obfuscate diagnosis given generalized ocular signs, including eyelid thickening and conjunctival irritation, and may occur in 26-51% of sebaceous carcinomas. [67]

Previous