Abstract
Purpose :
To describe clinical characteristics and outcomes of ocular sebaceous carcinoma (SC).
Methods :
Retrospective, cohort study of all patients managed for ocular SC between 1/1/2000–12/31/2022 at Mayo Clinic.
Results :
There were 25 patients with biopsy-confirmed, unilateral ocular SC diagnosed at mean age 72.6±11.1 years. Pertinent SC risk factors included breast cancer (12%), prior radiation (8%), ipsilateral retinoblastoma (4%), and lymphoma (4%). Nineteen (76%) patients were externally referred and presented 343±521 days after SC-related symptom onset. Nineteen (76%) were initially diagnosed as blepharitis or blepharoconjunctivitis (9), chalazion (6), other neoplasm (2), scar tissue (1), or trichiasis (1). The upper lid was involved in 16 (64%) eyes, and both lids in 3 (12%) eyes. Mean presenting logMAR visual acuity (VA) was 0.44 ± 0.44 (20/55 Snellen). Map biopsies were initially obtained in 21 eyes, of which 9 (42.9%) had at least one positive map. Primary SC treatment involved wide local excision (WLE) (44%), Mohs surgery (24%), exenteration (16%), exenteration with radiation (4%), Mohs with WLE (4%), or WLE with cryotherapy (4%). One patient declined definitive treatment after neoadjuvant mitomycin C. Ten (40%) had positive margins after primary intervention and underwent further re-excision (6), cryotherapy (1), re-excision with cryotherapy (1), Mohs with cryotherapy (1), or radiation (1). Mean follow-up duration was 41.1±53.5 months. Five (20%) had SC recurrence 21.4±18.6 months after primary management, of which 1 developed metastasis. Of 3 eyes for which exenteration was initially recommended but, per patient preference, underwent globe-sparing management, 1 had SC recurrence. Of the other 17 eyes managed with globe-sparing therapy, 3 had SC recurrence, with 1 requiring exenteration. Following primary SC treatment, mean VA was 0.34±0.59 (20/44, n=14) at 12 months and 0.28±0.33 (20/38, n=17) at final visit. Of eyes with delayed diagnosis (vs. no delay after initial presentation), 4 (21.1%) required primary exenteration with mean final VA of salvaged eyes 0.28±0.33 (20/38) vs. 1 (16.7%) required primary exenteration with final VA 0.26±0.35 (20/36).
Conclusions :
Ocular SC is complex, with frequently delayed diagnosis and a need for established treatment guidelines. Management is often multidisciplinary and individually tailored, commonly requiring multi-stage interventions.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.