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Timtim E, Barahimi B, Mawn LA, Sobel RK. Sebaceous carcinoma masquerading as ocular mucous membrane pemphigoid. Orbit 2024; 43:531-534. [PMID: 37097073 DOI: 10.1080/01676830.2023.2204489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/12/2023] [Indexed: 04/26/2023]
Abstract
Sebaceous carcinoma is a known mimicker of benign conditions, leading to frequent delays in diagnosis and proper treatment. We present two patients with chronic cicatrizing conjunctivitis initially diagnosed as ocular mucous membrane pemphigoid (MMP) and later found to have sebaceous carcinoma. Both patients presented with unilateral conjunctivitis that failed to improve with topical and systemic therapy, eventually developing fornix foreshortening and extensive symblepharon. Case 1 was diagnosed with ocular MMP based on clinical features alone, while Case 2 was diagnosed with biopsy-negative disease. Months to years later, both patients developed lid lesions found to be sebaceous carcinoma and underwent exenteration. As diagnosis and treatment of ocular MMP without positive direct immunofluorescence testing becomes increasingly accepted, clinicians should consider sebaceous carcinoma as the initial diagnosis or as a developing phenomenon during immunosuppression in the setting of chronic inflammation. A low threshold for repeat biopsy should be maintained.
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Affiliation(s)
- Elise Timtim
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Behin Barahimi
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Louise A Mawn
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rachel K Sobel
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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2
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Utikal J, Nagel P, Müller V, Becker JC, Dippel E, Frisman A, Gschnell M, Griewank K, Hadaschik E, Helbig D, Hillen U, Leiter U, Pföhler C, Krönig L, Ziemer M, Ugurel S. S1-Guideline Sebaceous Carcinoma. J Dtsch Dermatol Ges 2024; 22:730-747. [PMID: 38679790 DOI: 10.1111/ddg.15405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/19/2024] [Indexed: 05/01/2024]
Abstract
Sebaceous gland carcinomas are rare malignant cutaneous adnexal tumors with sebocytic differentiation. The typical predilection area is the head and neck region, where sebaceous gland carcinomas are the most common malignant adnexal tumors of the skin. According to their localization a distinction is made between periocular and extraocular sebaceous gland carcinomas. Muir-Torre syndrome (MTS) should always be ruled out if it is suspected. In terms of prognosis, sebaceous gland carcinomas are potentially aggressive tumors with a clear tendency to recur and metastasize. Only small extraocular sebaceous gland carcinomas that have been completely resected have a very good prognosis. Sebaceous gland carcinomas most frequently metastasize lymphogenously to regional or distant lymph nodes; organ metastasis occurs less frequently. Periocular sebaceous gland carcinomas have a higher metastasis rate (up to 15%) than extraocular sebaceous gland carcinomas (up to 2%). Complete micrographically controlled surgery (MCS) of the primary tumor is the therapy of first choice, regardless of periocular or extraocular localization. Adjuvant or therapeutic radiotherapy may be considered. There is currently no established standard therapy for advanced, inoperable, or metastatic sebaceous gland carcinomas. Local procedures and systemic therapies such as chemotherapy or immunotherapy can be considered. The procedure should be determined individually by an interdisciplinary tumor board. Close follow-up care is recommended for these potentially aggressive carcinomas.
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Affiliation(s)
- Jochen Utikal
- Clinical Cooperation Unit Dermato-Oncology of the German Cancer Research Center (DKFZ) Heidelberg and the Department of Dermatology, Venereology and Allergology, Medical Faculty Mannheim, Ruprecht Karl University Heidelberg, Mannheim, Germany
- DKFZ Hector Cancer Institute, University Medical Center Mannheim, Mannheim, Germany
| | - Pia Nagel
- Clinical Cooperation Unit Dermato-Oncology of the German Cancer Research Center (DKFZ) Heidelberg and the Department of Dermatology, Venereology and Allergology, Medical Faculty Mannheim, Ruprecht Karl University Heidelberg, Mannheim, Germany
- DKFZ Hector Cancer Institute, University Medical Center Mannheim, Mannheim, Germany
| | - Verena Müller
- Clinical Cooperation Unit Dermato-Oncology of the German Cancer Research Center (DKFZ) Heidelberg and the Department of Dermatology, Venereology and Allergology, Medical Faculty Mannheim, Ruprecht Karl University Heidelberg, Mannheim, Germany
- DKFZ Hector Cancer Institute, University Medical Center Mannheim, Mannheim, Germany
| | - Jürgen C Becker
- Translational Skin Cancer Research, Department of Dermatology, University Medical Center Essen, and German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
| | - Edgar Dippel
- Department of Dermatology and Venereology, Ludwigshafen Medical Center, Ludwigshafen, Germany
| | - Alexander Frisman
- Department of Radiation Therapy, University Hospital Leipzig, Leipzig, Germany
| | - Martin Gschnell
- Department of Dermatology and Allergology, University Hospital Marburg, Marburg, Germany
| | - Klaus Griewank
- Department of Dermatology, Venereology and Allergology, University Medical Center Essen, Essen, Germany
| | - Eva Hadaschik
- Department of Dermatology, Venereology and Allergology, University Medical Center Essen, Essen, Germany
| | - Doris Helbig
- Department of Dermatology and Venereology, University Hospital Cologne, Cologne, Germany
| | - Uwe Hillen
- Department of Dermatology and Venereology, Vivantes Hospital Neukölln, Berlin, Germany
| | - Ulrike Leiter
- Center for Dermato-Oncology, Department of Dermatology, University Medical Center Tübingen, Tübingen, Germany
| | - Claudia Pföhler
- Department of Dermatology, Venereology and Allergology and Skin Tumor Center, Saarland University Medical School, Homburg, Homburg/Saar, Germany
| | - Lisa Krönig
- Department of Dermatology and Allergology, University Hospital Marburg, Marburg, Germany
| | - Mirjana Ziemer
- Department of Dermatology, Venereology and Allergology, University Hospital Leipzig, Leipzig, Germany
| | - Selma Ugurel
- Department of Dermatology, Venereology and Allergology, University Medical Center Essen, Essen, Germany
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3
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Utikal J, Nagel P, Müller V, Becker JC, Dippel E, Frisman A, Gschnell M, Griewank K, Hadaschik E, Helbig D, Hillen U, Leiter U, Pföhler C, Krönig L, Ziemer M, Ugurel S. S1‐Leitlinie Talgdrüsenkarzinom. J Dtsch Dermatol Ges 2024; 22:730-749. [PMID: 38730519 DOI: 10.1111/ddg.15405_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/19/2024] [Indexed: 05/13/2024]
Abstract
Sebaceous gland carcinomas are rare malignant cutaneous adnexal tumors with sebocytic differentiation. The typical predilection area is the head and neck region, where sebaceous gland carcinomas are the most common malignant adnexal tumors of the skin. According to their localization a distinction is made between periocular and extraocular sebaceous gland carcinomas. Muir-Torre syndrome (MTS) should always be ruled out if it is suspected. In terms of prognosis, sebaceous gland carcinomas are potentially aggressive tumors with a clear tendency to recur and metastasize. Only small extraocular sebaceous gland carcinomas that have been completely resected have a very good prognosis. Sebaceous gland carcinomas most frequently metastasize lymphogenously to regional or distant lymph nodes; organ metastasis occurs less frequently. Periocular sebaceous gland carcinomas have a higher metastasis rate (up to 15%) than extraocular sebaceous gland carcinomas (up to 2%). Complete micrographically controlled surgery (MCS) of the primary tumor is the therapy of first choice, regardless of periocular or extraocular localization. Adjuvant or therapeutic radiotherapy may be considered. There is currently no established standard therapy for advanced, inoperable or metastatic sebaceous gland carcinomas. Local procedures and system therapies such as chemotherapy or immunotherapy can be considered. The procedure should be determined individually in an interdisciplinary tumor board. Close follow-up care is recommended for these potentially aggressive carcinomas.
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Affiliation(s)
- Jochen Utikal
- Klinische Kooperationseinheit Dermatoonkologie des Deutschen Krebsforschungszentrums (DKFZ) Heidelberg und der Klinik für Dermatologie, Venerologie und Allergologie, Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, Mannheim, Deutschland
- DKFZ Hector Krebsinstitut an der Universitätsmedizin Mannheim
| | - Pia Nagel
- Klinische Kooperationseinheit Dermatoonkologie des Deutschen Krebsforschungszentrums (DKFZ) Heidelberg und der Klinik für Dermatologie, Venerologie und Allergologie, Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, Mannheim, Deutschland
- DKFZ Hector Krebsinstitut an der Universitätsmedizin Mannheim
| | - Verena Müller
- Klinische Kooperationseinheit Dermatoonkologie des Deutschen Krebsforschungszentrums (DKFZ) Heidelberg und der Klinik für Dermatologie, Venerologie und Allergologie, Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, Mannheim, Deutschland
- DKFZ Hector Krebsinstitut an der Universitätsmedizin Mannheim
| | - Jürgen C Becker
- Translationale Hautkrebsforschung, Klinik für Dermatologie, Universitätsmedizin Essen, und Deutsches Krebsforschungszentrum (DKFZ), Heidelberg
| | - Edgar Dippel
- Klinik für Dermatologie und Venerologie, Klinikum der Stadt Ludwigshafen
| | - Alexander Frisman
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Leipzig
| | - Martin Gschnell
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Marburg
| | - Klaus Griewank
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen
| | - Eva Hadaschik
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen
| | - Doris Helbig
- Klinik und Poliklinik für Dermatologie und Venerologie, Uniklinikum Köln
| | - Uwe Hillen
- Klinik für Dermatologie und Venerologie, Vivantes Klinikum Neukölln, Berlin
| | - Ulrike Leiter
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik Tübingen, Universitätsklinikum Tübingen
| | - Claudia Pföhler
- Universitätsklinikum des Saarlandes, Klinik für Dermatologie, Venerologie und Allergologie und Hauttumorzentrum am UKS, Homburg/Saar
| | - Lisa Krönig
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Marburg
| | - Mirjana Ziemer
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig AöR, Leipzig
| | - Selma Ugurel
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen
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Ioannidis A, Kyrodimos E, Riga D, Nikolopoulos I, Giotakis AI. Parotid Metastasis of Early-Stage Upper Eyelid Sebaceous Carcinoma: A Case Presentation and a Literature Review. Cureus 2024; 16:e56838. [PMID: 38654808 PMCID: PMC11037876 DOI: 10.7759/cureus.56838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2024] [Indexed: 04/26/2024] Open
Abstract
Metastasis from early-stage sebaceous carcinoma of the eyelid to the salivary glands is considered very rare, occurring in less than 3% of early-stage patients. We report the case of a 72-year-old Caucasian man with a parotid tumor. Fine needle aspiration was consistent with a salivary duct carcinoma. A subtotal parotidectomy with ipsilateral neck dissection was performed. The pathology report revealed a sebaceous carcinoma with one parotid and two cervical lymph nodes infiltrated. The patient had a history of an early-stage sebaceous carcinoma of the upper eyelid two years before, which was revealed after the histological examination. An early-stage eyelid sebaceous carcinoma can metastasize to lymph nodes of the parotid glands. A close follow-up should not be neglected.
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Affiliation(s)
- Athanasios Ioannidis
- Otolaryngology, Head and Neck Surgery, Hippocration Hospital, University of Athens, Athens, GRC
| | - Efthymios Kyrodimos
- Otolaryngology, Head and Neck Surgery, Hippocration Hospital, University of Athens, Athens, GRC
| | - Dimitra Riga
- Pathology, Hippocration Hospital, University of Athens, Athens, GRC
| | | | - Aristeidis I Giotakis
- Otolaryngology, Head and Neck Surgery, Hippocration Hospital, University of Athens, Athens, GRC
- Otolaryngology, Head and Neck Surgery, Ippokrateio General Hospital of Athens, Athens, GRC
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5
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Dowell-Esquivel C, Lee R, DiCaprio RC, Nouri K. Sebaceous carcinoma: an updated review of pathogenesis, diagnosis, and treatment options. Arch Dermatol Res 2023; 316:55. [PMID: 38112896 DOI: 10.1007/s00403-023-02747-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/10/2023] [Accepted: 10/26/2023] [Indexed: 12/21/2023]
Abstract
Sebaceous carcinoma (SC) is a very rare and aggressive form of skin cancer that arises from the sebaceous glands. SC can occur anywhere on the body, but most commonly affects the head and neck, especially the upper eyelid. SC is the third most common malignancy of the eyelid and has the potential to metastasize and be fatal; therefore, it is vital for dermatologists to remain acquainted with this malignancy and its most current treatment options. Most commonly presenting as a painless lump or thickening of skin on the eyelid, SC has an insidious progression that may not prompt the patient to seek medical attention immediately. To avoid the potential of metastasis, early diagnosis and treatment is paramount. To assess if the cancer has spread, ophthalmology, imaging, and sentinel lymph node biopsy are recommended. This article provides a comprehensive review of SC's pathogenesis, current diagnostic methods, and treatments, including wide local excision, Mohs micrographic surgery, orbital exenteration, radiation, and other topicals. The prognosis of SC depends on several factors, including size, location, stage, and treatment method. After treatment of the neoplasm, diligent post-treatment surveillance remains the cornerstone of patient care. Continued dermatologic follow-ups are essential for early detection of reoccurrence, ensuring timely intervention and optimal long-term outcomes. In conclusion, this comprehensive review aims to equip dermatologists and other physicians with a nuanced understanding of SC, enabling them to provide effective care to support patients encountering this malignancy.
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Affiliation(s)
- Caitlin Dowell-Esquivel
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Dermatology Research Clinic, 1150 NW 14th Street, Miami, FL, 33136, USA.
| | - Raphael Lee
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Dermatology Research Clinic, 1150 NW 14th Street, Miami, FL, 33136, USA
| | - Robert C DiCaprio
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Dermatology Research Clinic, 1150 NW 14th Street, Miami, FL, 33136, USA
| | - Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Dermatology Research Clinic, 1150 NW 14th Street, Miami, FL, 33136, USA
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6
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Differentiating malignant and benign eyelid lesions using deep learning. Sci Rep 2023; 13:4103. [PMID: 36914694 PMCID: PMC10011394 DOI: 10.1038/s41598-023-30699-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 02/28/2023] [Indexed: 03/16/2023] Open
Abstract
Artificial intelligence as a screening tool for eyelid lesions will be helpful for early diagnosis of eyelid malignancies and proper decision-making. This study aimed to evaluate the performance of a deep learning model in differentiating eyelid lesions using clinical eyelid photographs in comparison with human ophthalmologists. We included 4954 photographs from 928 patients in this retrospective cross-sectional study. Images were classified into three categories: malignant lesion, benign lesion, and no lesion. Two pre-trained convolutional neural network (CNN) models, DenseNet-161 and EfficientNetV2-M architectures, were fine-tuned to classify images into three or two (malignant versus benign) categories. For a ternary classification, the mean diagnostic accuracies of the CNNs were 82.1% and 83.0% using DenseNet-161 and EfficientNetV2-M, respectively, which were inferior to those of the nine clinicians (87.0-89.5%). For the binary classification, the mean accuracies were 87.5% and 92.5% using DenseNet-161 and EfficientNetV2-M models, which was similar to that of the clinicians (85.8-90.0%). The mean AUC of the two CNN models was 0.908 and 0.950, respectively. Gradient-weighted class activation map successfully highlighted the eyelid tumors on clinical photographs. Deep learning models showed a promising performance in discriminating malignant versus benign eyelid lesions on clinical photographs, reaching the level of human observers.
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Morawala A, Mohamed A, Krishnamurthy A, Jajapuram SD, Kaliki S. Sebaceous gland carcinoma: analysis based on the 8 th edition of American Joint Cancer Committee classification. Eye (Lond) 2023; 37:714-719. [PMID: 35347292 PMCID: PMC9998849 DOI: 10.1038/s41433-022-02025-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 02/16/2022] [Accepted: 03/11/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To assess the prognostic value of T category of the 8th edition of American Joint Committee on Cancer (AJCC) classification in periocular sebaceous gland carcinoma (SGC). METHODS Retrospective interventional case series of 119 cases. RESULTS Based on the T category of 8th edition of AJCC classification, 119 periocular SGCs were classified into T1 (n = 33, 28%), T2 (n = 37, 31%) T3 (n = 17, 14%) and T4 (n = 32, 27%). There were no statistically significant differences in the rate of tumour recurrence based on T category. The outcome measures that showed significant increase with increase in T category included regional lymph node metastasis (3% for T1, 3% for T2, 12% for T3, and 44% for T4; p < 0.0001), systemic metastasis (0% for T1, 0% for T2, 12% for T3, and 25% for T4; p = 0.002) and death due to metastasis (0% for T1, 0% for T2, 12% for T3, and 22% for T4; p = 0.005). The 5-year Kaplan-Meier estimate rate for regional lymph node metastasis, systemic metastasis and metastasis-related death were all higher for the T4 category tumours (42%, p = 0.005; 34%, p = 0.0002; and 43%, p = 0.0001 respectively) compared to T1 (9%, 0%, and 0%), T2 (5%, 0%, and 0%) and T3 (10%, 17 and 8%) tumours. CONCLUSION Primary tumour (T) category of the 8th edition AJCC classification predicts the prognosis of patients with periocular SGC. The rates of lymph node metastasis, systemic metastasis, and death is much higher in T4 tumours compared to T1, T2, and T3 tumours. There was no association between T category and tumour recurrence.
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Affiliation(s)
- Ashi Morawala
- Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, India
| | - Ashik Mohamed
- Ophthalmic Biophysics (AMd), L V Prasad Eye Institute, Hyderabad, India
| | - Ajay Krishnamurthy
- Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, India
| | - Sai Divya Jajapuram
- Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, India
| | - Swathi Kaliki
- Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, India.
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Sen S, Bhardwaj M, Jayaraj P, Bakhshi S, Pushker N, Kashyap S, Bajaj MS, Khandpur S. Eyelid sebaceous gland carcinoma, validation of AJCC 8th edition T staging- a retrospective study from North India. Acta Ophthalmol 2023; 101:49-56. [PMID: 35751173 DOI: 10.1111/aos.15204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 05/20/2022] [Accepted: 05/31/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE This study compares the 8th edition staging of AJCC for prognosis of eyelid Sebaceous Gland Carcinoma (SGC) patients with respect to the 7th edition. METHODS A retrospective study was undertaken over a period of 100 months. Ninety-nine histopathologically proven cases of eyelid SGC available for follow-up were recruited. Patients were staged by both the 7th and 8th editions of AJCC and followed up at six monthly intervals after surgery. RESULTS Of the 99 eyelid SGC patients recruited, recurrence and orbital invasion developed in 22%, lymph node metastasis in 21% and 4% had distant metastasis and also died. High-risk features include tumour size>20 mm, orbital invasion, exenteration and staging by both the 7th and 8th editions of AJCC. Cox regression analysis revealed that staging by AJCC 8th edition was associated with greater risk for local recurrence (HR 3.01,95% CI-1.65-5.51%, p < 0.01) lymph node metastasis (HR 8.26, 95% CI 3.96-17.19%, p < 0.01) and disease-free survival (HR 4.61, 95% CI 2.81-7.54). The Kaplan-Meir survival curves of eyelid SGC patients by the 8th edition AJCC staging were also significantly associated with lymph node metastasis (p < 0.01), tumour-related deaths (p < 0.01) and reduced disease-free survival (p = 0.07). The higher Harrell's values by the 8th edition signify better predictive value for lymph node metastasis and DFS (disease-free survival). The lower AIC values indicate a better monotonicity of gradients for lymph node metastasis, recurrence and DFS. CONCLUSION Staging by the 8th AJCC edition is, therefore, recommended for eyelid SGC as it gives a better perspective about disease outcome. The orbital extension was the single most important predictor of lymph node metastasis, recurrence and death.
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Affiliation(s)
- Seema Sen
- Ocular Pathology Services, Dr.Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Mansi Bhardwaj
- Department of Molecular Medicine & Biotechnology, Sanjay Gandhi Post Graduate Institute of Medical Science (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Perumal Jayaraj
- Department of Zoology, Assistant Professor, Sri Venkateswara college, University of Delhi, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr.Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Neelam Pushker
- Department of Medical Oncology, Dr.Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Kashyap
- Ocular Pathology Services, Dr.Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Mandeep S Bajaj
- Department of Ophthalmology, Dr.Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sukhanshi Khandpur
- Department of Molecular Medicine & Biotechnology, Sanjay Gandhi Post Graduate Institute of Medical Science (SGPGIMS), Lucknow, Uttar Pradesh, India
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Mohs micrographic surgery for periocular skin cancer: a single-institution experience. Arch Dermatol Res 2022; 315:1181-1186. [DOI: 10.1007/s00403-022-02481-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/08/2022] [Accepted: 11/16/2022] [Indexed: 12/07/2022]
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10
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Han Y, Kong M, Luo Y, Sun B, Wang Z, Zhang H. Clinicopathological features of patients with wide local excision of eyelid malignant neoplasms: a more than five years retrospective study from China. BMC Ophthalmol 2022; 22:436. [PMCID: PMC9664722 DOI: 10.1186/s12886-022-02645-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
To investigate the correlation between the clinical and pathological characteristics and outcomes in patients with eyelid malignant tumors underwent wide local excision.
Methods
This retrospective study included 141 cases of eyelid malignant neoplasms from January 2010 to December 2015 in Shanxi eye hospital. Demographic and clinical information were collected. The Kaplan–Meier method was used to calculate survival curves, and the log-rank test method was used to compare survival between groups. Cox proportional regression models were used to calculate the hazard ratios (HR) of total recurrence rate and metastasis rate.
Results
Overall, there were 141 eyelid malignant neoplasms cases aged 65.34 ± 9.69 (range, 41—88) years old. The duration time range was from 1 to 828 (61.09 ± 122.21) months. Basal cell carcinoma (BCC) is the most common of all eyelid malignancies, accounting for 84 (59.5%), followed by Sebaceous gland carcinoma (SGC, 41, 29%), Squamous Cell Carcinoma (SCC, 11, 7.8%), Malignant Melanoma (MM, 3, 2.1%)。On cox-regression analysis, pathological classification (HR 1.959; 95% CI 1.012–3.790; p = 0.046) and eyelid tumor surgery history (HR 17.168; 95% CI 1.889–156.011; p = 0.012) were independently associated with recurrence in patients with eyelid malignant neoplasm. Pathological classification (HR 2.177; 95% CI 1.423 -3.331; p < 0.001) was independently associated with metastasis in patients with eyelid malignant neoplasm. Recurrence and metastasis were most likely to occur in 3 years after surgery.
Conclusion
Wide local excision is an effective and economical treatment for eyelid malignant neoplasms. The prognosis is mainly related to pathological types, eyelid tumor surgical history and TNM stages.
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11
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Gu X, Xie M, Luo Y, Song X, Xu S, Fan X. Diffuse pattern, orbital invasion, perineural invasion and Ki-67 are associated with nodal metastasis in patients with eyelid sebaceous carcinoma. Br J Ophthalmol 2022; 107:756-762. [PMID: 35063931 DOI: 10.1136/bjophthalmol-2021-320547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/04/2022] [Indexed: 11/04/2022]
Abstract
BackgroundMetastasis dominates the prognosis of eyelid sebaceous carcinoma (SC). This study aimed to explore risk factors for nodal metastasis and develop a nomogram to predict nodal metastasis in patients with eyelid SC.MethodsA retrospective case–control study was performed, comprising 320 patients with eyelid SC. Cox analyses were employed to investigate predictors of metastasis-free survival (MFS), and a nomogram was established and validated by the bootstrap method.ResultsForty patients (12.5%) developed nodal metastasis during a median follow-up of 48.0 months, and the median period between the initial treatment and first nodal metastasis was 18.5 months (range 6.0–80.0 months). The 1-year, 3-year and 5-year nodal metastasis rates were 5.5%, 12.5% and 15.4%, respectively. Diffuse pattern (HR: 4.34, 95% CI 1.75 to 10.76, p=0.002), orbital invasion at presentation (HR: 3.22, 95% CI 1.42 to 7.33, p=0.005), perineural invasion (HR: 3.24, 95% CI 1.11 to 9.49, p=0.032) and high Ki-67 percentage (HR: 1.03, 95% CI 1.01 to 1.05, p<0.001) were identified as independent risk factors for nodal metastasis. A nomogram that integrated these four factors had a C-index of 0.785, demonstrating a strong power in predicting nodal metastasis of eyelid SC.ConclusionsWe identified risk factors for nodal metastasis and developed a nomogram to provide individualised estimates of nodal metastasis for eyelid SC patients and guide postoperative management. This nomogram contained clinicopathological factors besides the T category of the TNM staging system and suggesting great clinical value.
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Affiliation(s)
- Xiang Gu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Minyue Xie
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yingxiu Luo
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xin Song
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Shiqiong Xu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xianqun Fan
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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12
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Griepp DW, Sajan A, Sighary M, Grigorian A. Adnexal carcinoma of the scalp: aggressive sebaceous differentiation with invasion of the orbital wall and thoracic vertebra. Clin Imaging 2021; 77:147-150. [PMID: 33684788 DOI: 10.1016/j.clinimag.2021.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/22/2020] [Accepted: 01/30/2021] [Indexed: 11/16/2022]
Abstract
Tumors of the scalp are characterized by a heterogeneous clinical spectrum with site-specific features. A wide variety of tumors that arise in the scalp include neoplasms, hamartomas, malformations, and both benign and malignant cysts. Most scalp tumors are benign (98-99%) with only an estimated 1-2% of diagnosed cases reported as being malignant. Of these, adnexal carcinoma is reported in less than 1% of cases. Herein, we report a 65-year-old woman who presented with pain and numbness in her hands with past medical history significant only for a chronic posterior head mass that had never received workup. Computerized topography (CT), magnetic resonance imaging (MRI), and local biopsy demonstrated a large, pedunculated malignant occipital mass that had metastasized to the orbital walls and cervical spine. To our knowledge, this is the largest sebaceous carcinoma to be reported occurring in the scalp. The present case emphasizes the need for older patients with benign scalp lesions to be closely monitored with frequent CT scans for signs of malignant transformation. Furthermore, it is important to diagnose malignant scalp tumors early as they tend to metastasize and cause diffuse symptomatology, which may ultimately result in increased patient mortality.
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Affiliation(s)
- Daniel W Griepp
- College of Medicine, New York Institute of Technology, 101 Northern Blvd, Old Westbury, NY, USA; Department of Radiology, SUNY Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY, USA
| | - Abin Sajan
- Department of Surgery, NYU Langone Hospital - Long Island, Mineola, 249 1st Street, Mineola, NY, USA.
| | - Maziar Sighary
- Department of Radiology, SUNY Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY, USA
| | - Arkadij Grigorian
- Department of Radiology, NYU Langone Hospital, 550 1st Ave, New York, NY, USA
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13
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Reynolds RR, Davies MJ, Buffam FV, Dolman PJ, White VA. Differences in 7th and 8th edition American Joint Committee on Cancer staging for periocular sebaceous carcinoma. CANADIAN JOURNAL OF OPHTHALMOLOGY 2021; 56:31-36. [PMID: 32822657 DOI: 10.1016/j.jcjo.2020.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/14/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine the clinicopathological features of periocular sebaceous carcinoma and describe the differences in T category between the seventh and eighth editions of the American Joint Committee on Cancer (AJCC) staging system for eyelid carcinoma in a Canadian population. METHODS This study is a single-centre retrospective review of consecutive patients diagnosed with periocular sebaceous carcinoma at Vancouver General Hospital over a 24-year period. Medical records and pathological slides were reviewed. Clinicopathological features, management, and outcomes were recorded. Each carcinoma was staged as per both the seventh and eighth editions AJCC staging system for eyelid carcinoma. RESULTS Forty-five patients (25 women, 20 men) were identified with a median age of 74 years (range 42-91 years). Tumour size was with a median of 4 mm (range 1-30 mm) and a mean of 6.7 mm. Using the seventh edition, patients were assigned the following T categories: Tis = 10, T1 = 9, T2 = 11, T3 = 8, T4 = 0. Under the eighth edition, 18 of 45 patients (40%) were restaged, with the majority of these (15 patients, 33%) being downstaged. The eighth edition categories were as follows: Tis = 10, T1 = 22, T2 = 3, T3 = 0, T4 = 3. Three patients developed disease recurrence, 2 of whom (staged T2c and T4b) died of disease. CONCLUSIONS There were substantial differences in the seventh and eighth editions of AJCC for the staging of periocular sebaceous carcinoma. Our series had small tumours at presentation with infrequent recurrences or metastases. We found a high number of patients with in-situ-only disease.
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Affiliation(s)
- Roisin R Reynolds
- Department of Anatomic Pathology, Douglass Hanly Moir Pathology, Macquarie Park, NSW, Australia.
| | - Michael J Davies
- Department of Ophthalmology, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Frank V Buffam
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, B.C
| | - Peter J Dolman
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, B.C
| | - Valerie A White
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, B.C.; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, B.C.; International Agency for Research on Cancer, Lyon, France
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14
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Desiato VM, Byun YJ, Nguyen SA, Thiers BH, Day TA. Sebaceous Carcinoma of the Eyelid: A Systematic Review and Meta-Analysis. Dermatol Surg 2021; 47:104-110. [PMID: 33347004 DOI: 10.1097/dss.0000000000002660] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sebaceous carcinoma (SC) of the eyelid is a rare, aggressive malignancy associated with high rates of recurrence, metastasis, and tumor-related mortality. OBJECTIVE Provide a collective analysis of clinical presentations, management techniques, and outcomes, and compare outcomes of common treatment methods. METHODS AND MATERIALS Observational studies reporting management and outcomes of SC of the eyelid were included. Patient and clinical data were extracted, and meta-analysis of proportions was performed. RESULTS One thousand three hundred thirty-three subjects were included with a mean age of 65.2 years and 803 (60.2%) women. Of 647 initial diagnoses reported, 277 (42.8%) were correct, and the mean diagnostic delay was 14.7 months (range 8.5-34.8). The tumor location was reported in 1,246 subjects and involved the upper eyelid in 780 (62.6%), lower eyelid in 409 (32.8%), and 57 (4.8%) involved both. Overall rates of recurrence, metastasis, and tumor-related mortality were 15.9%, 12.1%, and 6.2%, respectively. There were no statistically significant differences in wide local excision (WLE) versus Mohs micrographic surgery (MMS) outcomes. CONCLUSION Sebaceous carcinoma of the eyelid is more common in women, on the upper eyelid, and is frequently misdiagnosed initially. Rate of recurrence, metastasis, and tumor-related mortality were similar in subjects managed with WLE versus MMS.
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Affiliation(s)
- Vincent M Desiato
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Young Jae Byun
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
- University of Central Florida College of Medicine, Orlando, Florida
| | - Shaun A Nguyen
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Bruce H Thiers
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Terry A Day
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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15
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AlHammad F, Edward DP, Alkatan HM, Elkhamary S, Iuliano A, Maktabi A, Al-Horani SED, Al-Sheikh O, Al Hussain H, Strianese D. Eyelid sebaceous gland carcinoma: An assessment of the T classification of the American Joint Committee of Cancer TNM staging system 8th versus 7th edition. Eur J Ophthalmol 2020; 31:2055-2063. [PMID: 32567368 DOI: 10.1177/1120672120936488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To assess the prognostic values of the T classification of the 8th edition of the American Joint Committee of Cancer staging system and compare it to the 7th edition. METHODS Multicenter retrospective study of patients with eyelid sebaceous gland carcinoma. The primary outcome measure was the differences between outcomes when tumors were staged with either 7th or 8th edition. The measures evaluated included presenting features, management, histopathology, metastasis, recurrence, and mortality. RESULTS Of the 60 patients (median age 73 years), 31 (51.7%) were females. A change in T staging occurred in 39 patients (65%) when the 8th edition was applied. Advanced categories (T3/T4) were significantly associated with nodal metastasis (p = 0.037) using the 8th edition criteria but not with the 7th edition (p = 0.066). The 8th edition T categorization significantly correlated with eye survival (p = 0.022) while the 7th edition did not (p = 0.058). Applying the 8th edition, category T4 at presentation was associated with a higher risk of nodal metastasis (p = 0.037) but not associated with local recurrence, distant metastasis, or tumor-related death (p = 0.281, p = 0.737, p = 0.319, respectively). T3/T4 category tumors were significantly associated with poor tumor differentiation (p = 0.001), and papillary histologic pattern (p = 0.024) but not with pagetoid spread (p = 0.056). CONCLUSION The application of the 8th edition AJCC staging system for eyelid SGC may accurately predict nodal metastasis. Local recurrence and distant metastasis were not significantly associated with T classification, using either edition. Poor tumor differentiation and papillary pattern were associated with T3/T4 categories suggesting that pathological features may assist in determining prognosis.
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Affiliation(s)
- Fatimah AlHammad
- King Khaled Eye Specialist Hospital- KKESH- Riyadh, Saudi Arabia.,Dhahran Eye Specialist Hospital, Dhahran, Saudi Arabia
| | - Deepak P Edward
- King Khaled Eye Specialist Hospital- KKESH- Riyadh, Saudi Arabia.,Department of Ophthalmology and Visual Science, University of Illinois College of Medicine, Chicago, IL, USA
| | - Hind M Alkatan
- Departments of Ophthalmology and Pathology, King Saud University, College of Medicine, Riyadh, Saudi Arabia
| | - Sahar Elkhamary
- King Khaled Eye Specialist Hospital- KKESH- Riyadh, Saudi Arabia
| | - Adriana Iuliano
- Department of Neuroscience, Reproductive Sciences and Dentistry- University of Naples "Federico II," School of Medicine, Naples, Italy
| | - Azza Maktabi
- King Khaled Eye Specialist Hospital- KKESH- Riyadh, Saudi Arabia
| | | | - Osama Al-Sheikh
- King Khaled Eye Specialist Hospital- KKESH- Riyadh, Saudi Arabia
| | | | - Diego Strianese
- King Khaled Eye Specialist Hospital- KKESH- Riyadh, Saudi Arabia.,Department of Neuroscience, Reproductive Sciences and Dentistry- University of Naples "Federico II," School of Medicine, Naples, Italy
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16
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Wu A, Rajak SN, Huilgol SC, James C, Selva D. Cutaneous sebaceous carcinoma. Australas J Dermatol 2020; 61:e283-e292. [PMID: 31956994 DOI: 10.1111/ajd.13234] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/03/2019] [Accepted: 12/14/2019] [Indexed: 12/19/2022]
Abstract
Cutaneous sebaceous carcinoma occurs almost exclusively on the head and neck and has a significant propensity for recurrence and metastasis. It is easily mistaken for benign conditions, resulting in inappropriate management. Thus, it is important to maintain a high index of suspicion. Despite previous reports, sebaceous carcinoma may occur with similar frequency in Asians and whites. Recent genetic data suggest there are multiple mutational groups of sebaceous carcinoma, paving the way for targeted treatment. After a diagnosis, investigations for staging and for Muir-Torre syndrome should be considered. The available evidence on the treatment options for sebaceous carcinoma is discussed, and specific recommendations for management are made.
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Affiliation(s)
- Albert Wu
- Department of Dermatology, Royal Adelaide Hospital, The University of Adelaide, Adelaide, South Australia, Australia
| | - Saul N Rajak
- Sussex Eye Hospital, Brighton and Sussex University Hospitals, Brighton, UK
| | - Shyamala C Huilgol
- Department of Dermatology, Royal Adelaide Hospital, The University of Adelaide, Adelaide, South Australia, Australia.,Adelaide Skin and Eye Centre, Adelaide, South Australia, Australia
| | - Craig James
- Clinpath Laboratories, Adelaide, South Australia, Australia
| | - Dinesh Selva
- Adelaide Skin and Eye Centre, Adelaide, South Australia, Australia.,South Australian Institute of Ophthalmology, Royal Adelaide Hospital, The University of Adelaide, Adelaide, South Australia, Australia
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