Management of recurrent sebaceous gland carcinoma

Lindsay A McGrath, Zanna I Currie, Hardeep Singh Mudhar, Jennifer H Y Tan, Sachin M Salvi, Lindsay A McGrath, Zanna I Currie, Hardeep Singh Mudhar, Jennifer H Y Tan, Sachin M Salvi

Abstract

Objective: To evaluate the incidence and management of recurrent periocular sebaceous gland carcinoma at a tertiary ocular oncology service in the United Kingdom.

Methods: This was a retrospective cohort study of 62 patients with sebaceous gland carcinoma treated between 2004 and 2017. A total of 10 eyes were treated for local recurrence. The following variables were recorded: age and sex of patient; tumour location, histological subtype; recurrence type; treatment and outcome.

Results: Of the 62 cases with eyelid SGC, 10 (16%) had recurrences during the study period and satisfied inclusion criteria. There were six (60%) females and four males in the recurrent group. The mean time interval between initial excision and tumour recurrence was 37 months (median 23 months; range 4 to 84 months). Four patients received cryotherapy to the lids and conjunctiva to control recurrent disease and two patients were treated with topical or intralesional chemotherapy. Four patients (40%) underwent orbital exenteration during the study period. Metastasis occurred in 20% over a mean follow-up of 113 months (median 106; range 47-184 months).

Conclusions: The risk factors for local recurrence of SGC after wide excision with paraffin section control were reported, and an approach to these recurrent lesions was proposed. The results of this study will help guide surgeons dealing with the medical and surgical conundrum of recurrent disease. The risk of recurrence is highest in the first 2 years after initial excision.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1. Conjunctival map biopsy specimen locations.
Fig. 1. Conjunctival map biopsy specimen locations.
Upper eyelid wedge resection. (1 and 2): Corresponding forniceal map biopsies; (3–6): Bulbar conjunctival biopsies in four quadrants; (7 and 8): Inferior forniceal map biopsies; (9 and 10): Inferior palpebral conjunctival biopsies. Plica and caruncle rarely biopsied unless suspicious appearance.
Fig. 2
Fig. 2
Proposed treatment flowchart for recurrent SGC.
Fig. 3. Recurrent SGC.
Fig. 3. Recurrent SGC.
a Medial upper eyelid recurrence at site of previous wedge excision; b Thickening and erythema representing recurrence at lateral upper lid margin; c New eyelid margin nodule lateral to previous wedge excision site; d diffuse madarosis and upper eyelid margin ulceration.

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