The Importance of Early Diagnosis of Sebaceous Cell Carcinoma of the Eyelid

Abstract

Purpose : Periocular Sebaceous Cell Carcinoma (SbCC) is a rare and malignant tumor of the sebaceous, oil-producing Meibomian glands. It is the most malignant tumor of the eyelid, with up to 33% leading to systemic disease. Pathological evaluation is critical since SbCC can even mimic benign lesions, such as chalazion. SbCC is more commonly seen on the upper eyelid, due to the high concentration of Meibomian glands in this region. The most important prognostic factor is time (6 months) between the onset and the diagnosis of the lesion. The presence of pagetoid spread is also relevant for prognosis. The aim of this study is to examine a large number of patients with SbCC to determine features of favorable or unfavorable prognosis.

Methods : A retrospective analysis was conducted on 62 patients pathologically diagnosed with SbCC at the MUHC-McGill University Ocular Pathology & Translational Research between 1994 and 2023. Data on age, sex and location were collected when available. The study involved a comparison between clinical suspicion and pathological diagnosis, examining pathological features, and immunohistochemical staining.

Results : Of the 62 cases, the average age was 73 years old and 52% (n=32) were males. A total of 56% (n=35) with the main initial clinical misdiagnoses being 16% (n=10) as unspecified carcinoma, 16% (n=10) as Basal Cell Carcinoma, and 10% (n=6) as chalazion. For location, 69% (n=43) were located on the eyelid, with 20 on the upper eyelid, 19 on the lower eyelid, and 4 unspecified as upper or lower eyelid. In addition, 13% (n=8) were exenterations. Pagetoid spread was observed in 26% (n=16) of cases. The immunohistochemical marker, adipophilin was highly positive in all the 9 cases it was performed in.

Conclusions : SbCC is a great mimicker. This fact reiterates the relevance of the pathological evaluation of all eyelid lesions to ensure proper care and earlier correct diagnosis. The location of the lesions being just as prevalent on the lower eyelid can be explained by the number of unusual SbCC received in our Unit. Immunohistochemistry using adipophilin is an important tool for the final diagnosis. The identification of pagetoid spread is crucial to define prognosis. Early detection and intervention are vital for a better patient outcome and quality of life.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.