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Seanna R Grob, N. Grace Lee, Francis Creighton, Frederick Jakobiec, Kevin Emerick, Suzanne K Freitag; Multispecialty approach to management of sebaceous carcinoma of the eyelids. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3430.
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To report a multispecialty approach to the management of periocular sebaceous carcinoma and the clinical outcomes of patients who have been treated with this approach.
Retrospective review of 6 patients with periocular sebaceous carcinoma managed by the Oculoplastics Service at Massachusetts Eye and Ear Infirmary (MEEI) was conducted. Data collected included duration of symptoms, previous ocular diagnoses, eyelids affected, method of excision and reconstruction, results of sentinel lymph node biopsy and metastatic work up, recurrence rate, and duration of follow up.
Six patients were identified (mean 70.5 years, 4 female). All were of a Caucasian background. Four patients had a family history of any cancer; only one patient had a prior history of skin cancer - basal cell carcinoma. Prior to evaluation at MEEI, four patients were diagnosed with blepharitis. The mean duration of symptoms prior to biopsy proven diagnosis and evaluation at MEEI was 28.5 months. The location of the sebaceous carcinoma was most commonly in the upper lids (4 patients). After diagnosis was confirmed by histopathologic analysis, all patients were evaluated by the head and neck oncology service at MEEI for discussion of sentinel lymph node biopsy, medical oncology for staging and metastatic work up, and radiation oncology for possible adjuvant therapy. An average of 2.2 total sentinel lymph nodes were removed per case. The parotid and cervical level 2 sentinel lymph node basins were the most common sites (each 50% of cases). Surgical margins were evaluated by frozen section and confirmed with rapid permanent section within 24 hours. All patients had negative lymph node biopsies and metastatic work ups on initial presentation. Only one patient has had recurrence since initiation of care at MEEI, but this patient had extensive eyelid and ocular surface disease on initial presentation.
The optimal management of sebaceous carcinoma of the ocular surface and adnexa requires an integrated multidisciplinary approach involving an ophthalmic plastic surgeon, a head and neck oncologist, a medical and radiation oncologist, experienced pathologists and radiologists, and at times, an anterior segment surgeon specializing in ocular surface tumors.<br />
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