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Yadlapati S, Rosa-Nieves PM, Mehta N, Merritt BG, Carrasquillo OY. Treatment of sebaceous carcinoma with Mohs micrographic surgery versus wide local excision: a systematic review. Int J Dermatol 2024. [PMID: 38856083 DOI: 10.1111/ijd.17283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 06/11/2024]
Abstract
Sebaceous carcinoma (SC) is a rare neoplasm affecting periocular and extraocular sites. If inadequately treated, it can recur and cause morbidity. Specific management guidelines have not been established. Wide local excision (WLE) has been traditionally used; however, Mohs micrographic surgery (MMS) can be advantageous because of complete margin assessment and tissue-sparing nature. This analysis aims to systematically review the surgical modalities used for the management of SC. Articles meeting eligibility criteria were identified using MEDLINE (via PubMed), Embase, Cochrane, and Scopus databases. All studies investigating surgical management of SC with WLE or MMS were considered. Seventy studies met inclusion criteria, including retrospective cohort studies, case series, and case reports. WLE was used in 32 studies, MMS in 29, and MMS and WLE in 9. Subgroup analysis showed that MMS has lower recurrence rates. For WLE, local, regional, and distant recurrence rates were 23.4%, 13.3%, and 11.0%, respectively, and for MMS, 6.8%, 4.3%, and 4.6%, respectively. Patients treated with WLE were more likely to have local recurrence than patients treated with MMS (P = 0.001). WLE cases were more likely to have a regional (P = 0.05) and distant recurrence (P = 0.001). Limitations of the study include heterogeneity of case reports, case series, and retrospective studies, variable follow-up times between the two groups, and large tumors included in the WLE category. In addition, disease-specific survival was not evaluated. MMS cases showed a superior outcome for local, regional, and distant recurrence, making it a good option for the management of SC.
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Affiliation(s)
- Sujitha Yadlapati
- HCA Corpus Christi Medical Center-Bay Area Dermatology Residency Program, McAllen, TX, USA
| | | | - Nina Mehta
- Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Bradley G Merritt
- Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Osward Y Carrasquillo
- Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Dini F, Susini P, Nisi G, Cuomo R, Grimaldi L, Massi D, Innocenti A, Doni L, Mazzini C, Santoro N, De Giorgi V. Periocular sebaceous carcinoma: updates in the diagnosis, treatment, staging, and management. Int J Dermatol 2024; 63:726-736. [PMID: 38351466 DOI: 10.1111/ijd.17045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 05/25/2024]
Abstract
Periocular sebaceous carcinoma (PSC) is a rare, aggressive, and potentially metastatic adnexal malignancy. Due to the ability of PSC to resemble several benign and malignant conditions, diagnosis is often delayed or mistaken. In addition, even with a known diagnosis, choosing the right treatment is still an open debate. For this reason, we decided to review the most up-to-date literature on PSC and propose a dedicated procedural protocol to help clinicians when dealing with PSC. A PubMed search was carried out using the terms "Sebaceous Carcinoma", "Adnexal Periocular Cancer", "Sebaceous Carcinoma AND eyelid", "Periocular Sebaceous Carcinoma", and "Ocular Adnexa". Pertinent studies published in English from 1997 up to December 2022 were compared to the selection criteria and if suitable, included in this review. Through the initial search, 84 articles were selected. Of these, 36 were included in the final study. Several papers explored different diagnostic and therapeutic strategies regarding PSC diagnosis and management. In light of the current literature review and the multidisciplinary experience of three clinical centers, a dedicated procedural protocol is proposed. PSC diagnosis may be achieved through accurate clinical evaluation, but it requires histopathologic confirmation, which can be challenging. Dermoscopy, in vivo reflectance confocal microscopy, and optical coherence tomography may facilitate PSC clinical examination, while immunohistochemistry stains may support histological diagnosis. Appropriate disease staging is necessary before choosing the treatment, as local disease requires radically different treatment compared to advanced disease. In addition, recent innovations in nonsurgical treatments, including radio-chemotherapy, immunotherapy, and targeted therapy, may be a viable option in the most challenging cases.
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Affiliation(s)
- Federica Dini
- Department of Neurosciences, Psychology, Drug Research and Child Health Eye Clinic, University of Florence, Florence, Italy
| | - Pietro Susini
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Giuseppe Nisi
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Roberto Cuomo
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Luca Grimaldi
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Daniela Massi
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Alessandro Innocenti
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy
| | - Laura Doni
- Clinical Oncology Unit, University Hospital Careggi, Florence, Italy
| | - Cinzia Mazzini
- Unit of Ocular Oncology, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy
| | - Nicola Santoro
- Unit of Ocular Oncology, Department of Surgery and Translational Medicine, Careggi University Hospital, Florence, Italy
| | - Vincenzo De Giorgi
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
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3
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Kibbi N, Petric UB, El-Banna G, Beaulieu DM, Rajan N, Srivastava D, Aasi SZ. Clinical Outcomes in Sebaceous Carcinoma: A Retrospective Two-Center Cohort Study. Dermatol Surg 2023; 49:1122-1127. [PMID: 37962979 DOI: 10.1097/dss.0000000000004016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND Sebaceous carcinoma (SC) is a rare, potentially recurrent, and life-threatening cutaneous malignancy that can be associated with Muir-Torre syndrome (MTS), a DNA mismatch repair-driven genodermatosis. Earlier studies examining factors associated with recurrence have focused on periocular tumors only. OBJECTIVE Examine outcomes of SC and identify factors associated with recurrence. MATERIALS AND METHODS Retrospective study from 2 tertiary care centers. RESULTS Sixty-seven cases from 63 patients were identified, including 7 cases of MTS and 13 arising in the context of immunosuppression. Fifty-five cases (82.1%) were treated with complete circumferential peripheral and deep margin assessment (CCPDMA) methods. Five recurrences developed during the postoperative period. On univariate analysis, periocular location (odds ratio [OR] 7.6, p = .0410), and lesion size ≥2 cm (OR 9.6, p = .005) were associated with recurrence, whereas CCPDMA (OR 0.052, p = .0006) was inversely associated with recurrence. On multivariate analysis, only lesion size ≥2 cm (OR 9.6, p = .0233) and CCPDMA approaches (OR 0.052, p = .007) were significant. CONCLUSION Non-complete circumferential peripheral and deep margin assessment methods and large lesion size were independent risk factors predicting recurrence, whereas anatomic subtype and MTS status were not. These findings can assist in identifying SC cases that may benefit from more aggressive treatment and closer surveillance.
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Affiliation(s)
- Nour Kibbi
- Department of Dermatology, Stanford University Medical Center, Redwood City, California
| | - Ursa B Petric
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ghida El-Banna
- Department of Dermatology, Stanford University Medical Center, Redwood City, California
| | - Derek M Beaulieu
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Neil Rajan
- Biosciences Institute, Newcastle University, Newcastle Upon Tyne, UK
- Department of Dermatology and NIHR Newcastle Biomedical Research Centre, Newcastle Hospitals NHS Foundation, Newcastle upon Tyne, UK
| | - Divya Srivastava
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sumaira Z Aasi
- Department of Dermatology, Stanford University Medical Center, Redwood City, California
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Sebaceous Carcinoma of the Face Treated With Mohs Micrographic Surgery. Dermatol Surg 2022; 48:1148-1154. [PMID: 36194726 DOI: 10.1097/dss.0000000000003603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Mohs micrographic surgery (MMS) for sebaceous carcinoma (SC) may reduce local recurrence rates, but published case series have small cohorts and limited follow-up. Mohs micrographic surgery is particularly suitable for sensitive functional and cosmetic locations, such as the face, because it facilitates tissue conservation using complete peripheral and deep margin assessment before reconstruction. Coordinated care between Mohs and oculoplastic surgeons has not been described. OBJECTIVE To assess rates of local recurrence and metastasis after MMS of facial SC and to describe coordinated care between Mohs and oculoplastic surgeons. MATERIALS AND METHODS Retrospective review identified facial SC cases treated with MMS at a single institution from January 2005 to August 2020. Tumor characteristics and outcomes were recorded. Descriptive and predictive analyses were performed. RESULTS Forty-nine cases were reviewed with a mean follow-up of 51 months. The most common sites were periorbital, infraorbital cheek, and nasal ala. No patients experienced regional recurrence after MMS. One patient with Muir-Torre syndrome developed metastatic recurrence (at 82.9 months). All patients underwent 2-stage reconstruction with dermatology-performed MMS and oculoplastic reconstruction. CONCLUSION Collaboration between Mohs and oculoplastic surgeons with a tissue-sparing approach of MMS can reduce recurrence and optimize cosmesis and function for central facial SC.
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Pediatric Cutaneous Oncology. Dermatol Clin 2022; 41:175-185. [DOI: 10.1016/j.det.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Aggarwal D, Jain V. Rare malignant adnexal tumour of the skin involving distal phalanx of right thumb with co-existing primary lung cancer in a 72-year-old patient: A case report. Int J Surg Case Rep 2022; 95:107174. [PMID: 35569312 PMCID: PMC9112114 DOI: 10.1016/j.ijscr.2022.107174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/05/2022] [Accepted: 05/07/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction and importance Malignant adnexal tumours of the skin are a group of rare malignancies. These tumours can further differentiate into eccrine, apocrine, sebaceous, sweat duct, or ceruminous glands within the skin or follicular cells. Sebaceous carcinoma, a malignant adnexal tumour of the skin, is a rare and malignant tumour of the sebaceous glands. They can occur anywhere in the body where sebaceous glands are present, the most common being the head and neck region. Case report Here we report a case of a 72-year-old man who presented with a bleeding ulcer on the distal right thumb, which was progressively increasing in size. Biopsy and histology confirmed the diagnosis of MATS with sebaceous differentiation. He had been diagnosed with metastatic non-small cell lung carcinoma six months back. Clinical discussion and conclusion SC is a rare and unusual tumour amounting to less than 1% of all cutaneous malignancies. Phalanges are an infrequent extra-ocular site of involvement, and initial presentation can be mistaken for a benign occurrence. Any patient presenting with extra-ocular SC is advised to undergo genetic and immunohistochemistry testing to rule out complex genetic syndromes like Muir Torre syndrome and Cowden syndrome. Ulcerating proliferative lesion on the distal phalanx of the right thumb in 72-year-old man with primary non-small cell lung malignancy. Malignant adnexal tumor of the skin (MATS), a rare group of malignancies, are a diagnostic challenge for both surgeons and pathologist Sebaceous carcinoma, an aggressive tumor, account for approximately 1% of all skin malignancies Extra-ocular sebaceous carcinoma warrants investigations for complex genetic syndromes such as Muir Torre and Cowden syndrome. Surgery is the main treatment modality. Depending on location of the tumor, wide local excision, Mohs micrographic surgery or CCPDMA can be done.
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Affiliation(s)
- Deepika Aggarwal
- Department of General Surgery, Mata Chanan Devi Hospital, New Delhi, India.
| | - Vimal Jain
- Department of General Surgery, Mata Chanan Devi Hospital, New Delhi, India
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Peterson C, Moore R, Hicks JL, Morsberger LA, De Marzo AM, Zou Y, Eberhart CG, Campbell AA. NGS Analysis Confirms Common TP53 and RB1 Mutations, and Suggests MYC Amplification in Ocular Adnexal Sebaceous Carcinomas. Int J Mol Sci 2021; 22:8454. [PMID: 34445161 PMCID: PMC8395148 DOI: 10.3390/ijms22168454] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/01/2021] [Accepted: 08/04/2021] [Indexed: 01/31/2023] Open
Abstract
Ocular adnexal (OA) sebaceous carcinomas generally demonstrate more aggressive clinical and histopathological phenotypes than extraocular cases, but the molecular drivers implicated in their oncogenesis remain poorly defined. A retrospective review of surgical and ocular pathology archives identified eleven primary resection specimens of OA sebaceous carcinomas with adequate tissue for molecular analysis; two extraocular cases were also examined. Next-generation sequencing was used to evaluate mutations and copy number changes in a large panel of cancer-associated genes. Fluorescence in situ hybridization (FISH) confirmed MYC copy number gain in select cases, and immunohistochemistry to evaluate MYC protein expression. The commonest mutations occurred in TP53 (10/13) and RB1 (7/13). Additional mutations in clinically actionable genes, or mutations with a frequency of at least 25%, included the NF1 (3/12), PMS2 (4/12), ROS1 (3/12), KMT2C (4/12), MNX1 (6/12), NOTCH1 (4/12), PCLO (3/12), and PTPRT (3/12) loci. Low level copy number gain suggestive of amplification of the MYC locus was seen in two cases, and confirmed using FISH. MYC protein expression, as assessed by immunohistochemistry, was present in almost all sebaceous carcinoma cases. Our findings support the concept that alterations in TP53 and RB1 are the commonest alterations in sebaceous carcinoma, and suggest that MYC may contribute to the oncogenesis of these tumors.
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Affiliation(s)
- Cornelia Peterson
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
| | - Robert Moore
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (R.M.); (J.L.H.); (L.A.M.); (A.M.D.M.); (Y.Z.)
| | - Jessica L. Hicks
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (R.M.); (J.L.H.); (L.A.M.); (A.M.D.M.); (Y.Z.)
| | - Laura A. Morsberger
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (R.M.); (J.L.H.); (L.A.M.); (A.M.D.M.); (Y.Z.)
- Clinical Cytogenetics Laboratory, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Johns Hopkins Genomics, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Angelo M. De Marzo
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (R.M.); (J.L.H.); (L.A.M.); (A.M.D.M.); (Y.Z.)
- Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- The Brady Urological Research Institute, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Ying Zou
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (R.M.); (J.L.H.); (L.A.M.); (A.M.D.M.); (Y.Z.)
- Clinical Cytogenetics Laboratory, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Johns Hopkins Genomics, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Charles G. Eberhart
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (R.M.); (J.L.H.); (L.A.M.); (A.M.D.M.); (Y.Z.)
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Ashley A. Campbell
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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Extraocular Sebaceous Carcinoma Treated With Mohs Micrographic Surgery-A 24-Year Retrospective Review of Tumor Characteristics and Treatment Outcomes. Dermatol Surg 2021; 47:1195-1199. [PMID: 34107496 DOI: 10.1097/dss.0000000000003105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Extraocular sebaceous carcinoma (SC) is rare, with distinct features from its ocular counterpart. These neoplasms have been associated with Muir-Torre syndrome (MTS). Associated internal malignancies include gastrointestinal and genitourinary. OBJECTIVE Assess for local recurrence, metastasis, disease-specific death, and additional malignancies in patients with extraocular SC treated with Mohs micrographic surgery (MMS) at a single referral center. METHODS Review of patients with extraocular SC treated with MMS between 1995 and 2019. Follow-up was obtained by chart review. RESULTS Thirty-eight patients with 41 tumors were identified (25, 66% male). During a mean follow-up of 5.9 ± 5 years, one case of metastasis was identified in an incompletely treated case. No recurrence was identified in the remaining 40 tumors. Five of 41 (12%) tumors had aggressive histologic features. Seven of 38 (18%) patients had a diagnosis of MTS or associated risk factors. There was no association between MTS or its risk factors and high-risk tumors. CONCLUSION There were no incidences of local recurrence, metastasis, or disease-specific death in cases treated completely with MMS. Metastasis and disease-specific death occurred in an incompletely treated case, highlighting the risk associated with aggressive tumors.
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Mohs micrographic surgery: a review of indications, technique, outcomes, and considerations. An Bras Dermatol 2021; 96:263-277. [PMID: 33849752 PMCID: PMC8178571 DOI: 10.1016/j.abd.2020.10.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/26/2020] [Accepted: 10/05/2020] [Indexed: 01/10/2023] Open
Abstract
Mohs micrographic surgery is a specialized form of skin cancer surgery that has the highest cure rates for several cutaneous malignancies. Certain skin cancers can have small extensions or “roots” that may be missed if an excised tumor is serially cross-sectioned in a “bread-loaf” fashion, commonly performed on excision specimens. The method of Mohs micrographic surgery is unique in that the dermatologist (Mohs surgeon) acts as both surgeon and pathologist, from the preoperative considerations until the reconstruction. Since Dr. Mohs’s initial work in the 1930s, the practice of Mohs micrographic surgery has become increasingly widespread among the dermatologic surgery community worldwide and is considered the treatment of choice for many common and uncommon cutaneous neoplasms. Mohs micrographic surgery spares the maximal amount of normal tissue and is a safe procedure with very few complications, most of them managed by Mohs surgeons in their offices. Mohs micrographic surgery is the standard of care for high risks basal cell carcinomas and cutaneous squamous cell carcinoma and is commonly and increasingly used for melanoma and other rare tumors with superior cure rates. This review better familiarizes the dermatologists with the technique, explains the difference between Mohs micrographic surgery and wide local excision, and discusses its main indications.
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Kadam SS, Kadam T, Jigjinni V, M H S. Sebaceous Cell Carcinoma of the Lower Eyelid in an Elderly Male: a Rare Case Report and Review of Literature. Indian J Surg Oncol 2021; 12:224-227. [PMID: 33994751 DOI: 10.1007/s13193-021-01305-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 02/25/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
- Sachin S Kadam
- Department of Surgical Oncology, Vedant Cancer and Multispeciality Hospital, Mumbai, India
| | - Tejaswini Kadam
- Department of Ophthalmology, Conwest & Jain Superspeciality Eye Hospital, Mumbai, India
| | - Vishwanath Jigjinni
- Department of Plastic and Reconstructive Surgery, Kamalnayan Bajaj Cancer Center, Pune, India
| | - Sanjay M H
- Department of Radiation Oncology, Sahyadri Hospital, Pune, India
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Elias ML, Skula SR, Behbahani S, Lambert WC, Schwartz RA. Localized sebaceous carcinoma treatment: Wide local excision verses Mohs micrographic surgery. Dermatol Ther 2020; 33:e13991. [PMID: 32645237 DOI: 10.1111/dth.13991] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/19/2020] [Accepted: 07/06/2020] [Indexed: 01/28/2023]
Abstract
The optimal surgical management of sebaceous carcinoma (SC) has yet to be determined between Mohs micrographic surgery (MMS) and wide local excision (WLE). To investigate overall survival (OS) differences for SC undergoing WLE or MMS, The National Cancer Database (NCDB) was queried for all SC from 2004 to 2015 (n = 2863). Cases missing staging data, undergoing palliative care, showing lymph node extension, or of AJCC Stage III/IV were omitted. Chi-squared tests were used to analyze patient demographics, cancer characteristics, and treatment modalities. Kaplan-Meier and Cox proportional hazards regression modeling analyzed OS outcomes. A total of 554 cases met inclusion criteria (WLE [n = 243], MMS [n = 311]). Multivariate analysis revealed that cases treated in academic facilities (ref: non-acad; OR = 2.273; CI95% [1.448-3.568]; P < .001] were independently associated with greater MMS rates, whereas those with primaries on the trunk (ref: head/neck OR = 0.359; CI95%[0.203-0.634]; P < .001) and extremities (ref: head/neck OR = 0.399; CI95% [0.182-0.877]; P = .022) held lower MMS rates. Between surgical modalities, Kaplan-Meier survival showed no significant difference in outcomes (P = .611), with WLE and MMS demonstrating 5-year OS rates of 65.8% and 61.4%, respectively. On Cox proportional hazard regression, the survival outcomes of MMS and WLE did not show any significant differences in OS (HR = 0.832; CI95% [0.996-3.662]; P = .334). MMS and WLE of localized SC demonstrate similar overall survival outcomes. MMS may be preferred for margin control, tissue conservation, and cosmesis.
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Affiliation(s)
| | | | | | | | - Robert A Schwartz
- Dermatology and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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12
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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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Comparison of Mohs Surgery and Surgical Excision in the Treatment of Localized Sebaceous Carcinoma. Dermatol Surg 2019; 45:1125-1135. [DOI: 10.1097/dss.0000000000001780] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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14
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Phan K, Loya A. Mohs micrographic surgery versus wide local excision for sebaceous adenocarcinoma of the eyelid : Analysis of a national database. J Plast Reconstr Aesthet Surg 2019; 72:1007-1011. [DOI: 10.1016/j.bjps.2019.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/27/2019] [Accepted: 02/17/2019] [Indexed: 11/24/2022]
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15
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Abstract
BACKGROUND Mohs micrographic surgery (MMS) is a frequently used technique that provides total margin visualization for treatment of skin neoplasms. OBJECTIVE To provide a comprehensive review of MMS literature, focusing on its origins, evidence behind present-day uses of MMS, and future directions. METHODS A literature search was conducted using PubMed to identify articles pertaining to MMS. RESULTS The fresh frozen technique led to widespread use of MMS in the 1970s. One randomized controlled trial and several large prospective studies have demonstrated low recurrence rates for treatment of nonmelanoma skin cancer (NMSC). MMS, when compared with surgical excision, also achieved a statistically significant higher cure rate for treatment of recurrent NMSC. Studies have demonstrated low recurrence for the treatment of melanoma and melanoma in situ with MMS. MMS has also been shown to effectively treat several rare cutaneous neoplasms. The future of MMS is likely to include the adoption of noninvasive imaging, immunostaining, and digital technology. CONCLUSION Mohs micrographic surgery is an effective treatment modality for numerous cutaneous neoplasms. It has achieved statistically significant superiority to surgical excision for the treatment of recurrent and high-risk NMSC. The future is likely to see increased use of noninvasive imaging, immunostaining, and digital technology.
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Affiliation(s)
- Diana K Cohen
- Skin Laser & Surgical Specialists of NY and NJ, Hackensack, New Jersey
| | - David J Goldberg
- Skin Laser & Surgical Specialists of NY and NJ, Hackensack, New Jersey
- Icahn School of Medicine at Mt. Sinai, New York, New York
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16
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Murray C, Sivajohanathan D, Hanna TP, Bradshaw S, Solish N, Moran B, Hekkenberg R, Wei AC, Petrella T. Patient indications for Mohs micrographic surgery: a clinical practice guideline. Curr Oncol 2019; 26:e94-e99. [PMID: 30853814 PMCID: PMC6380643 DOI: 10.3747/co.26.4439] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective The purpose of the present work was to develop evidence-based indications for Mohs micrographic surgery in patients with a diagnosis of skin cancer. Methods The guideline was developed by Cancer Care Ontario's Program in Evidence-Based Care, together with the Melanoma Disease Site Group and the Surgical Oncology Program, through a systematic review of relevant literature, patient- and caregiver-specific consultation, and internal and external reviews. Recommendation 1 Given a lack of high-quality, comparative evidence, surgery (with postoperative or intraoperative margin assessment) or radiation (for those who are ineligible for surgery) should remain the standard of care for patients with skin cancer. Recommendation 2 Mohs micrographic surgery is recommended for patients with histologically confirmed recurrent basal cell carcinoma of the face and is appropriate for primary basal cell carcinomas of the face that are larger than 1 cm, have aggressive histology, or are located on the H zone of the face. Recommendation 3 Mohs micrographic surgery should be performed by physicians who have completed a degree in medicine or equivalent, including a Royal College of Physicians and Surgeons of Canada Specialist Certificate or equivalent, and have received advanced training in Mohs micrographic surgery.
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Affiliation(s)
- C Murray
- Division of Dermatology, Women's College Hospital, and University of Toronto, Toronto, ON
| | - D Sivajohanathan
- Department of Oncology, McMaster University, and Program in Evidence-Based Care, Cancer Care Ontario, Hamilton, ON
| | - T P Hanna
- Department of Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston, ON
| | | | - N Solish
- Division of Dermatology, Women's College Hospital, and University of Toronto, Toronto, ON
| | - B Moran
- Division of Dermatology, Queen's University, Kingston, ON
| | - R Hekkenberg
- Department of Surgery, Royal Victoria Regional Health Centre, and Surgical Oncology Program, Cancer Care Ontario, Barrie, ON
| | - A C Wei
- Quality and Knowledge Transfer, Surgical Oncology Program, Cancer Care Ontario, Toronto and, ON
| | - T Petrella
- Department of Medical Oncology, Odette Cancer Centre, Toronto, ON
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Zhou C, Wu F, Chai P, Shi Y, Ye J, Shi X, Tan J, Ding Y, Luo Y, Esmaeli B, Jia R, Fan X. Mohs micrographic surgery for eyelid sebaceous carcinoma: A multicenter cohort of 360 patients. J Am Acad Dermatol 2019; 80:1608-1617.e1. [PMID: 30639290 DOI: 10.1016/j.jaad.2018.12.053] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 12/12/2018] [Accepted: 12/18/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND The decision to perform Mohs micrographic surgery (MMS) or wide local excision (WLE) for eyelid sebaceous carcinoma (SC) is controversial. OBJECTIVE To compare local recurrence, metastasis, and tumor-related mortality of patients with eyelid SC who were initially treated with MMS versus with WLE. METHODS A multicenter cohort study. Medical records were reviewed for factors associated with recurrence, metastasis, and tumor-related mortality. All eligible patients were followed up. The impact of initial surgical modality on the prognoses were determined by Cox analyses after control for all confounders. RESULTS Of the 360 patients included in this cohort, 115 (31.9%) underwent MMS as primary resection, whereas 245 (68.1%) underwent WLE. After a median follow-up period of 60.0 months, local recurrence was observed in 18 patients (15.7%) in the MMS group and 97 patients (39.6%) in the WLE group. Metastasis occurred in 9 patients (7.8%) who underwent MMS and 38 (15.5%) who underwent WLE. In all, 6 patients in the MMS group (5.2%) and 21 in the WLE group (8.6%) died of metastatic SC. Multivariable Cox regression indicated that compared with the WLE group, the MMS group exhibited more favorable local recurrence control (hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.24-0.73; P = .002) but a comparable metastasis rate (HR, 1.38; 95% CI, 0.60-3.18; P = .453) and comparable tumor-related mortality (HR, 1.70; 95% CI, 0.59-4.93; P = .329). However, this beneficial effect became nonremarkable for patients with pagetoid intraepithelial neoplasia (HR, 1.73; 95% CI, 0.37-8.21; P = .488). LIMITATIONS Retrospective nature of the study. CONCLUSION MMS should be proposed for eyelid SC without orbital involvement to achieve recurrence control; however, this surgical procedure did not change the long-term outcomes in terms of metastasis or tumor-related mortality. Patients with pagetoid intraepithelial neoplasia may require adjuvant measures.
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Affiliation(s)
- Chuandi Zhou
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Fan Wu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Peiwei Chai
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yingyun Shi
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Juan Ye
- Department of Ophthalmology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Xin Shi
- Department of Ophthalmology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Jia Tan
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Yi Ding
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 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, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Bita Esmaeli
- Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Renbing Jia
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 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, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China.
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Zhang LL. MiR-449b inhibits the migration and invasion of colorectal cancer cells through the negative regulation of MMP2. ACTA ACUST UNITED AC 2018. [DOI: 10.31491/csrc.2018.9.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
PURPOSE OF REVIEW Periocular sebaceous cell carcinoma is a rare malignancy that is often misdiagnosed leading to increased morbidity and mortality. This review aims to describe current knowledge on the disease to aid clinicians in timely diagnosis and treatment. RECENT FINDINGS New research has shown that the diagnosis of sebaceous cell carcinoma can be aided with immunohistochemical stains. A revision in the American Joint Committee on Cancer staging system incorporates new tumor size classifications in the staging of eyelid carcinomas. Wide local excision and Mohs micrographic surgery continue to represent the standard of care for initial treatment of localized disease. SUMMARY The current review highlights diagnostic and treatment modalities to allow clinicians to make timely diagnosis and tailor treatment plans for individual patient presentations.
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Murray C, Sivajohanathan D, Hanna TP, Bradshaw S, Solish N, Moran B, Hekkenberg R, Wei AC, Petrella T. Patient Indications for Mohs Micrographic Surgery: A Systematic Review. J Cutan Med Surg 2018; 23:75-90. [PMID: 30033747 DOI: 10.1177/1203475418786208] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The purpose of the present review was to describe evidence-based indications for Mohs micrographic surgery (MMS) in patients with a diagnosis of skin cancer. Relevant studies were identified from a systematic MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews search of studies published from 1970 to 2017. Randomized controlled trials (RCTs), prospective and retrospective comparative studies with greater than 30 patients, and single-arm retrospective studies with multivariate analyses were included. A total of 2 RCTs, 3 prospective studies, and 16 retrospective studies (14 comparative and 2 single-arm) were included. Data on recurrence rate, cure rate, complications, cosmesis, and quality of life were extracted. Surgery (with postoperative or intraoperative marginal assessment) or radiation for those who are ineligible for surgery should remain the standard of care for patients with skin cancer given the lack of high-quality, comparative evidence. MMS is recommended for those with histologically confirmed recurrent basal cell carcinoma (BCC) of the face and is appropriate for primary BCCs of the face that are >1 cm, have aggressive histology, or are located on the H zone of the face. The available evidence is difficult to generalize to all patients with skin cancer because the evidence did not adequately cover non-BCC skin cancers; however, those skin cancers can be considered on a case-by-case basis for MMS. MMS should be performed by physicians who have completed a degree in medicine or equivalent, including a Royal College of Physicians and Surgeons of Canada Specialist Certificate or equivalent, and have received advanced training in MMS.
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Affiliation(s)
- Christian Murray
- 1 Division of Dermatology, Women's College Hospital & University of Toronto, Toronto, ON, Canada
| | - Duvaraga Sivajohanathan
- 2 Department of Oncology, McMaster University & Program in Evidence-Based Care, Cancer Care Ontario, Hamilton, ON, Canada
| | - Timothy P Hanna
- 3 Department of Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston, ON, Canada
| | | | - Nowell Solish
- 1 Division of Dermatology, Women's College Hospital & University of Toronto, Toronto, ON, Canada
| | - Benvon Moran
- 5 Division of Dermatology, Queen's University, Kingston, ON, Canada
| | - Robert Hekkenberg
- 6 Department of Surgery, Royal Victoria Regional Health Centre & Surgical Oncology Program, Cancer Care Ontario, Barrie, ON, Canada
| | - Alice C Wei
- 7 Quality and Knowledge Transfer, Surgical Oncology Program, Cancer Care Ontario, Toronto, ON, Canada
| | - Teresa Petrella
- 8 Department of Medical Oncology, Odette Cancer Centre, Toronto, ON, Canada
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Cicinelli MV, Kaliki S. Ocular sebaceous gland carcinoma: an update of the literature. Int Ophthalmol 2018; 39:1187-1197. [DOI: 10.1007/s10792-018-0925-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 04/13/2018] [Indexed: 02/07/2023]
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Abstract
BACKGROUND Adnexal carcinomas (ACs) are rare cutaneous malignancies of sweat gland or pilosebaceous origin. Optimal treatment and metastatic potential of AC are poorly defined. Mohs micrographic surgery (MMS) has been increasingly used to treat AC. OBJECTIVE To review selected primary cutaneous AC and their treatment outcomes with MMS. MATERIALS AND METHODS Literature review using PubMed search for articles related to primary cutaneous ACs. RESULTS Sebaceous carcinoma treated with MMS recurred and metastasized in 6.4% and 3.7%, respectively. Primary cutaneous mucinous carcinoma treated with MMS recurred and metastasized in 9.6% and 6.4%, respectively. After MMS, 4.7% of microcystic AC recurred with no reported metastases. After MMS, recurrences and metastases of trichilemmal carcinoma or hidradenocarcinoma have not been reported. Two (4.2%) regional lymph node metastases but no distant metastases or local recurrences have been reported in eccrine porocarcinoma. Squamoid eccrine duct tumor, pilomatrix carcinoma, and spiradenocarcinoma treated with MMS are also reviewed. CONCLUSION The rarity of ACs and the lack of comparative data on treatment makes conclusive recommendations on treatment difficult. Recent large case series and reviews suggest MMS is a useful and possibly superior treatment for AC and should be considered if primary cutaneous disease is suspected.
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Park SK, Park J, Kim HU, Yun SK. Sebaceous Carcinoma: Clinicopathologic Analysis of 29 Cases in a Tertiary Hospital in Korea. J Korean Med Sci 2017; 32:1351-1359. [PMID: 28665073 PMCID: PMC5494336 DOI: 10.3346/jkms.2017.32.8.1351] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/13/2017] [Indexed: 11/20/2022] Open
Abstract
Sebaceous carcinoma (SC) is a neoplasm derived from the adnexal epithelium of the sebaceous glands, and most studies on this neoplasm have been conducted in Caucasians. We retrospectively reviewed the records of 29 patients with SC (16 extraocular and 13 ocular lesions) who were diagnosed from 2001 to 2014 to analyze the clinical and histopathological features of SC in the Korean population. Sixteen of the patients were women and 13 were men. There was an equal sex distribution for extraocular lesions, and a female predilection (M:F = 1:1.6) for ocular lesions. The mean ages at presentation of extraocular and ocular lesions were 69.19 ± 37.19 (range, 32-87) and 67.46 ± 24.46 (range, 43-85) years, respectively. Most lesions occurred in the eyelid (13/29, 44.83%), and most extraocular lesions occurred in the head and neck area (13/16, 81.25%). There was no recurrence or death during the follow-up period. Most lesions were poorly differentiated (extraocular, 43.75%; ocular, 38.46%), had a lobular infiltrative growth pattern (extraocular, 68.75%; ocular, 76.92%), and were basaloid (extraocular, 56.25%; ocular, 61.54%). Only 5 cases (2 extraocular and 3 ocular lesions) showed pagetoid spread. Extraocular lesions were marginally more common than the ocular form. There were higher incidences in elderly patients, who also had the highest incidence of eyelid lesions. The proportion of cells with sebaceous differentiation and prominent growth patterns were variable. Our results show that SC may not be very aggressive in Koreans.
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Affiliation(s)
- Su Kyung Park
- Department of Dermatology, Chonbuk National University Hospital, Jeonju, Korea
| | - Jin Park
- Department of Dermatology, Chonbuk National University Hospital, Jeonju, Korea
- Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Han Uk Kim
- Department of Dermatology, Chonbuk National University Hospital, Jeonju, Korea
- Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Seok Kweon Yun
- Department of Dermatology, Chonbuk National University Hospital, Jeonju, Korea
- Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.
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Abstract
BACKGROUND Sebaceous carcinoma is a rare and potentially aggressive adnexal neoplasm with historic data indicating high rates of recurrence, metastasis, and cancer-specific mortality. OBJECTIVE To evaluate the incidence of local recurrence, metastasis, disease-specific mortality, and all-cause mortality and to identify work-up approaches. PATIENTS AND METHODS/MATERIALS Retrospective review of patients with sebaceous carcinoma treated with Mohs micrographic surgery between 2001 and 2013 at one institution. RESULTS Thirty-seven patients had 45 sebaceous carcinomas located on the periocular region (13%), non-periocular face (47%), scalp (7%), neck (4%), trunk (9%), and extremities (20%). The mean age was 66.1 years, and 24 (65%) patients were male. Five patients had Muir-Torre syndrome (MTS) or Lynch syndrome. Seven of 12 tumors showed loss of expression of ≥1 mismatch repair gene. The most common work-up involved taking a detailed personal and family medical history. No local recurrences, metastases, or disease-specific deaths occurred during an average follow-up of 3.6 years. CONCLUSION Mohs micrographic surgery is an effective treatment for sebaceous carcinoma. Detailed history taking, age-appropriate cancer screening, and immunohistochemical staining with MLH1, MSH2, or MSH6 is helpful in identifying which patients should be referred to a geneticist for work-up of MTS.
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Hoss E, Nelson SA, Sharma A. Sebaceous carcinoma in solid organ transplant recipients. Int J Dermatol 2017; 56:746-749. [PMID: 28181233 DOI: 10.1111/ijd.13490] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/01/2016] [Accepted: 09/12/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Though a rare tumor, sebaceous carcinoma is relatively well-described in immunocompetent patients, in whom it often occurs in a periorbital distribution where it has an overall poor prognosis with a high metastasis rate. The effect of transplant-related immunosuppression on the development of sebaceous carcinoma and its outcomes has not been characterized. METHODS We collected 9 cases from a single institution of patients developing sebaceous carcinoma after solid organ transplantation. We analyzed clinicopathologic features. RESULTS We estimate the prevalence of sebaceous carcinoma post-solid organ transplantation to be 0.09%. The mean age at diagnosis was 66.1 years (std 7.0 years). The mean time between transplantation and sebaceous carcinoma diagnosis was 7.1 years (std 5.1 years). All tumors occurred in extra-ocular distribution. Two patients likely had Muir-Torre syndrome, of whom 1 died from metastatic sebaceous carcinoma. No other patients developed metastatic disease or had disease-related death. Mohs micrographic surgery and wide local excision were equally effective and there were no recurrences with either procedure. CONCLUSIONS Our study found that sebaceous carcinoma in solid organ transplant recipients occurs in in an extraorbital distribution with only 1 patient developing metastatic disease. Both Mohs micrographic surgery and wide local excision are acceptable treatment modalities for sebaceous carcinoma in transplant recipients.
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Affiliation(s)
- Elika Hoss
- Mayo Clinic Arizona, Scottsdale, AZ, USA
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Abstract
BACKGROUND Extraocular sebaceous carcinoma (SC) is a rare malignancy with metastatic potential. The authors present a case of a rapidly growing extraocular SC with equivocal radiographic imaging to highlight challenges in tumor management. OBJECTIVE To examine the existing literature for evaluation and management recommendations of extraocular SC. METHODS AND MATERIALS A comprehensive review of relevant English articles in PubMed through May 2015. RESULTS Tumor-specific staging system and management guidelines do not currently exist for extraocular SC. Mohs micrographic surgery or wide local excision are the most commonly used surgical treatments. Regional/distant metastasis occurs infrequently, but systemic workup with radiographic imaging or sentinel lymph node biopsy may be warranted in select cases. Adjuvant radiation therapy can be considered for recurrent and metastatic tumors. CONCLUSION Extraocular SCs present unique challenges that may benefit from multidisciplinary management. Surgical removal with negative pathologic margins is the mainstay treatment of extraocular SC. Additional studies will help clarify the optimal diagnostic workup and adjuvant treatment of patients.
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Aggressive extraocular sebaceous carcinoma recurring after mohs micrographic surgery. Case Rep Oncol Med 2015; 2015:534176. [PMID: 25685571 PMCID: PMC4320911 DOI: 10.1155/2015/534176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 12/28/2014] [Accepted: 12/31/2014] [Indexed: 11/18/2022] Open
Abstract
Sebaceous carcinomas (SC) are rare adnexal tumors with possible aggressive behavior usually arising in the head and neck region of adults in the seventh decade of life. Treatment has traditionally been with surgical excision with 5-6 mm wide margins but Mohs micrographic surgery (MMS) has also been reported as an effective treatment modality. We present a case of a Caucasian female renal transplant patient with a rapidly enlarging nodule on the left preauricular cheek that was excised with MMS with negative margins. The tumor recurred rapidly and metastasized ultimately leading to the death of the patient. There was some disagreement amongst pathologists as to the possible nature of the diagnosis with the original biopsy being labeled as a poorly differentiated carcinoma. We aim to highlight the potential aggressive nature of SC and review the features of the neoplasm including histological features that help in making the diagnosis.
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