Oculoplastics

42 3 Eyelid Neoplasms

SEBACEOUS ADENOCARCINOMA S ebaceous adenocarcinoma is a highly ma lignant and potentially fatal tumor that arises from the sebaceous glands of the eyelid. In the early stages, this tumor can be difficult to recognize, and once it grows, it is difficult to contain, because it can have skip areas. Early recognition and aggressive excision are the keys to successful treatment. Epidemiology and Etiology ● Age: Usually older than 50 years ● Gender: More common in females than males ● Etiology: Arises from the meibomian glands, glands of Zeis, or sebaceous glands of the caruncle, eyebrow, or facial skin History ● Often starts as a chronic blepharitis or non resolving chalazion ● Patients may have a chronic red, irritated eye for months to years. Examination ● Multiple potential presentations: ■ Nodular lesion simulating a chalazion ■ Unilateral chronic blepharitis ■ Cellular membrane growing over the conjunctiva ■ Destructive, often ulcerated, lesion on the eyelid margin ( Fig. 3-6 ) ■ Occurrence in the upper eyelid is twice as common as in the lower eyelid.

Special Considerations ● This lesion is the great masquerader. Delay in diagnosis as a carcinoma and subsequent growth of the lesion add to the poor progno sis for this tumor. Differential Diagnosis ● Basal cell carcinoma ● Squamous cell carcinoma ● It is important to alert your pathologist if this sebaceous adenocarcinoma is suspected. ● Special stains have been used in the past to confirm the presence of intracytoplasmic lip ids (Oil Red O). Immunohistochemical stains are now used to confirm the diagnosis. ● Without these stains, the lesion may be misdiagnosed. Treatment ● Clinically diagnosing the lesion is often the biggest challenge. ● Biopsy of any suspicious lesion is the key. ● Once diagnosed, complete excision with wide, controlled margins is the treatment of choice. ● There can be skip areas, so careful follow-up for recurrence is needed. Prognosis ● This is a potentially lethal tumor that must be treated aggressively. ● Chronic blepharitis ● Chronic chalazion Pathophysiology

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