Abstract
Purpose :
Sebaceous carcinoma (SC) is a malignancy of sebaceous glands that most commonly presents on the ocular surface (OaSC). Intraepithelial (pagetoid) invasion of OaSC remains a challenge to manage. Chemotherapeutic agents (Mitomycin-C [MMC] and (5-Fluorouracil [5FU]) have been shown to be effective in vitro. Topical Mitomycin C (0.04%) has been shown to be clinically effective in treating OaSC. The purpose of this study is to report on the outcomes of topical chemotherapeutic agents in treating intraepithelial invasion of OaSC at a single institution.
Methods :
This is a retrospective, single institution, case series study conducted under the approval of University of Miami’s Institutional Review Board between the years of 2000 and 2023 (n=10). Inclusion criteria: (1) biopsy proven pagetoid invasion of SC within the ocular surface and (2) implementation of topical chemotherapy as adjuvant therapy. Patient demographics, anatomic site, laterality, chemotherapy regimen, and clinical course were obtained from medical records. Topical chemotherapy agents utilized were: MMC (0.02% or 0.04%), 5-FU, and Interferon alpha 2b (IFN). Chemotherapy was administered continuous or via rest cycles. The efficacy of chemotherapy evaluated via repeat map biopsy and histopathologic evaluation.
Results :
A total of 10 patients were included in this study. The mean age was 70.5 years (Range: 39-84 years). Primary tumor sites included: upper eyelid (7), lower eyelid (2), and caruncle (1). Resolution of pagetoid spread was achieved in two patients with topical MMC 0.02%. Recurrence of pagetoid spread was present in eight patients. Orbital exenteration was performed in seven of those cases, with one patient undergoing palliative care.
Conclusions :
We present 10 advanced cases of OaSC that were treated with a variety of topical chemotherapy for pagetoid spread. We note a high recurrence rate within our series with the majority of these patients ultimately requiring orbital exenteration, highlighting the continued challenge of treating OaSC. Despite clearance of pagetoid spread from the ocular surface following topical chemotherapy, residual tumor may be present within meibomian glands/hair follicles. This study serves to caution against the use of mono-modality topical chemotherapy for OaSC with pagetoid spread.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.