1/11. radiation therapy for local control of eyelid sebaceous cell carcinoma: report of two cases and review of the literature.PURPOSE: Because of previous reports of increased rate of recurrence and mortality after radiation therapy, eyelid sebaceous cell carcinoma has been considered radioresistant. Recent reports of success with primary radiation therapy have been attributed to advancements in irradiating technology and technique. Two cases of eyelid sebaceous cell carcinoma successfully treated with radiation therapy are reported. The techniques used are compared with the techniques described in previous reports, and factors favoring successful treatment are reevaluated. methods: Case series and review of the literature. Two cases of eyelid sebaceous cell carcinoma that underwent radiation therapy are described. Both patients were offered, but refused, surgical excision. One patient received 69 Gy combined superficial and megavoltage x-ray irradiation to the left lower eyelid. The second patient received 59 Gy megavoltage electron beam irradiation to the right upper eyelid. A review of the literature was performed, and Fisher's exact test analysis was used to compare the results of all reported cases treated with < or =55 Gy with those treated with >55 Gy. RESULTS: In both cases, the tumor responded to radiation therapy. One patient died 39 months after treatment, of myocardial infarction. The second patient is without clinical evidence of tumor recurrence 46 months after treatment. Fisher's exact test showed an advantage to patients treated with >55 Gy radiation (p = 0.05). CONCLUSION: radiation therapy with an appropriate delivery system is effective as a curative treatment for eyelid sebaceous cell carcinoma when >55 Gy of radiation dose is delivered. It should be considered for patients seeking an alternative to surgical excision.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
2/11. Sebaceous carcinoma of the eyelids treated by mohs micrographic surgery: report of nine cases with review of the literature.BACKGROUND: Ocular sebaceous carcinoma (SC) is a rare tumor of the eyelids. Clinically it frequently involves the upper lid in older women. Microscopically it tends to extend far beyond its assessed clinical margins. SC is characterized by a variety of tissue invasion mechanisms. It may spread by direct extension, be multifocal in advanced cases, and develop "skip areas" after trauma. Despite its ability to develop discontinuity, over the past two decades there have been several favorable case reports of SC treated by Mohs micrographic surgery (MMS). OBJECTIVE: To illustrate by case report the clinical presentation and management of patients with SC and to document our series of SC patients treated by MMS over the last 14 years. methods: A retrospective study was conducted of all cases of sebaceous carcinoma involving the ocular adnexa treated at the University of wisconsin mohs surgery Clinic from 1987 to 2001. We also reviewed the accumulated medical literature of SC treated by MMS. RESULTS: In our series, there were nine cases of periocular SC. Five cases originated on the upper lid and four on the lower lid. Five of nine patients (55%) showed epithelial invasion. One patient developed a local recurrence 1.5 years later and was treated by orbital exenteration. This patient has had no evidence of disease for 5 years. Eight of nine patients (88%) had no evidence of local recurrence with a follow-up of 1-14 years. In our literature review we found 40 additional cases of orbital SC treated by MMS. Intraepithelial spread of SC was found in 50% of patients (24 of 48). Six patients developed local recurrence. The overall local cure rate following MMS is 87.8% (43 of 49), with a mean follow-up of 3.1 years. The regional metastatic rate was 8% (4 of 49). There were no deaths reported. CONCLUSION: We present nine new cases of SC. The age, sex, and site distribution are compatible with other SC cases reported in the literature. We reviewed the medical literature and compiled 49 cases of SC treated by mohs surgery. Intraepithelial spread was discovered in 50% of the cases. Multifocal disease or discontinuity was present in 6% (3 of 49). mohs surgery appears to be an effective method for excising the microscopic ramifications of primary SC. When feasible, we recommend in SC cases where intraepithelial pagetoid spread has been observed, that removal of another Mohs layer should be considered in order to provide an additional assurance layer against local tumor recurrence.- - - - - - - - - - ranking = 2keywords = upper (Clic here for more details about this article) |
3/11. Eyelid sebaceous carcinoma masquerading as in situ squamous cell carcinoma.BACKGROUND: Sebaceous carcinoma (SC) accounts for 1% to 5.5% of all eyelid malignancies. Diagnosis is often delayed because of its ability to masquerade as other periocular lesions both clinically and histologically. OBJECTIVE: To promote a high index of suspicion among Mohs surgeons for SC when managing biopsy-proven in situ squamous cell carcinoma (SCC) of the eyelid, particularly the upper eyelid. methods: This is a retrospective case review. RESULTS: A 77-year-old woman and a 71-year-old man were referred for Mohs micrographic surgery with a diagnosis of upper eyelid in situ SCC on biopsy. Intraoperatively, the presence of clear cell differentiation, in addition to extensive conjunctival involvement, leads to the correct diagnosis of SC. One case was subsequently found to have Muir Torre syndrome. CONCLUSION: early diagnosis of eyelid SC leads to a better outcome and a higher survival rate. Hence, when managing in situ SCC of the eyelids, particularly the upper eyelid, Mohs surgeons should be aware of the possibility of SC and actively look for sebaceous cell differentiation or extensive conjunctival spread.- - - - - - - - - - ranking = 3keywords = upper (Clic here for more details about this article) |
4/11. Sebaceous gland carcinoma of the eyelid presenting as a conjunctival papilloma.An unusual presentation of sebaceous carcinoma of the eyelid is described in a 96-year-old man who presented with a large papillomatous palpebral conjunctival lesion in the left upper eyelid. The patient underwent a shave excision of the lesion, followed by a full thickness excision with paraffin section margin control. Histopathology revealed a sebaceous gland carcinoma with no evidence of pagetoid spread. Although rare, sebaceous gland carcinoma should be considered in the differential diagnosis of a conjunctival papilloma.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
5/11. Morpheaform extra-ocular sebaceous carcinoma.BACKGROUND: Sebaceous carcinoma is an unusual, aggressive, malignant tumor derived from the epithelium of sebaceous glands. It may arise in ocular or extra-ocular sites and is often evident as an ulcerated or non-ulcerated cystic nodule measuring up to 8 cm in diameter. A significant number of extra-ocular sebaceous carcinomas have been associated with metastases and high mortality rate. methods AND RESULTS: We reviewed the literature in the context of our report of a 68-year-old woman who had a morpheaform plaque of the upper lip of 15 years duration, extending into the left naso-genal groove, which histologically also showed marked stromal fibrosis. Three years after excision, there were no signs of recurrence or metastases. CONCLUSIONS: This patient is unusual in clinical and histologic pattern, as a morpheaform appearance has only been described previously in only one sebaceous carcinoma. In addition, no metastatic disease 15 years after tumor onset is a fortunate and remarkable feature.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
6/11. FNA diagnosis of recurrent sebaceous carcinoma.We describe fine-needle aspiration (FNA) diagnosis in a case of sebaceous carcinoma presenting as recurrent swelling eyelid. The patient, a 35-yr-old woman, presented with a gradually increasing painless mass in the left upper eyelid. She had a history of excisions of swelling at the same site over a period of 5 years. On FNA, the smears were cellular and demonstrated sheets, three dimensional clusters, and singly scattered polygonal tumor cells having centrally located hyperchromatic and pleomorphic nuclei and cytoplasmic microvacuolations. Oil red-O stain performed on air-dried smears showed positivity, confirming the presence of intracellular and extracellular lipid globules. A final impression of sebaceous carcinoma of the left upper eyelid was rendered, based on which the eyelid mass was radically excised. Subsequent histopathology confirmed the diagnosis. Despite wide excision, such tumors not uncommonly recur and metastasize. An early and accurate diagnosis of such lesions can be established on minimally invasive needle aspiration.- - - - - - - - - - ranking = 2keywords = upper (Clic here for more details about this article) |
7/11. Intraepithelial sebaceous carcinoma of the eyelid misdiagnosed as bowen's disease.BACKGROUND: Sebaceous carcinoma (SC) is well known for its ability to masquerade clinically and histologically as a variety of periocular conditions resulting in a delayed diagnosis. We present a series of periocular SC cases and discuss the difficulties in histopathological diagnosis when this tumor presents with a Bowenoid pattern of intraepithelial spread. methods: A retrospective case study of all patients with SC of the eyelid treated in our Hospital, from 1997 to 2004, was conducted. RESULTS: Eight patients were identified (four females and four males). Seven cases involved the upper eyelid. Initial clinical diagnoses included blepharitis (three cases), blepharoconjunctivitis (one case), cicatrizing conjunctivitis (one case), and lid lesions (two cases). Histopathologically, 87.5% of cases were misdiagnosed as bowen's disease (BD) on the initial biopsy. Six of these cases showed no invasive disease on the initial biopsy and were eventually found to be invasive SC on subsequent excisions. In one case, the tumor was wholly in situ. Delay in diagnosis ranged from 0 to 56 months. CONCLUSIONS: SC should always be considered in the histological differential diagnosis of any eyelid lesion which resembles BD, particularly if the upper eyelid is involved or if multivacuolated cytoplasmic clear cell changes are seen.- - - - - - - - - - ranking = 2keywords = upper (Clic here for more details about this article) |
8/11. Sebaceous gland carcinoma of the eyelid presenting as a conjunctival papilloma.A 70-year-old man complained of the sensation of having a foreign body in his left eye in June 1992. A papillary tumor was found growing from the palpebral conjunctiva of the left upper eyelid. On June 30, the conjunctival tumor was excised: the histopathologic findings indicated a malignancy. On August 18, full-thickness excision of the upper eyelid, including the rest of the tumor, was performed. Histopathologic findings showed a well-differentiated sebaceous gland carcinoma. We believe that sebaceous gland carcinoma presenting as conjunctival papilloma, as found in our patient, may be uncommon.- - - - - - - - - - ranking = 2keywords = upper (Clic here for more details about this article) |
9/11. Zeis gland carcinoma.Sebaceous carcinoma of the Zeis gland of the cilia is a rare malignant tumor. A 90-year-old Japanese man with a Zeis gland carcinoma on the left upper eyelid is reported. The tumor was a 12 x 3-mm, reddish, partially yellow, papillomatous nodule accompanied by loss of several lashes. Histologically, two types of tumor cells, a dark basaloid cell and a larger pale cell, showed lobular and comedo-acinar growth patterns. The carcinoma did not recur during the 8 months following surgery; however, the patient died of gastric carcinoma.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
10/11. Tarsal kinking after Hughes flap.A retrospective review of 45 patients undergoing the Hughes tarsoconjuctival flap procedure for lower eyelid reconstruction detected three individuals who developed kinking of the tarsus and upper eyelid margin. This unusual complication became apparent at the time of flap division. A horizontal band of fibrosis at the superior border of the remaining upper eyelid tarsus was appreciated in two of the patients. Excision of the fibrotic tissue resulted in an immediate improvement of the deformity.- - - - - - - - - - ranking = 2keywords = upper (Clic here for more details about this article) |
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