What Is Sebaceous Carcinoma?
Sebaceous carcinoma is a rare type of skin cancer that is aggressive in nature. The mortality rate with sebaceous carcinoma is high because it is a malignant tumor with an increased rate of spread.
Sebaceous carcinoma starts from the sebaceous glands, which produce sebum and are present almost everywhere in the skin. Since these glands are the site of origin, they can occur anywhere in the body where sebaceous glands are present. Eyelids are the most common site of occurence of sebaceous carcinoma. This is due to the fact that sebaceous glands are seen in large numbers in the areas present in and around the eyes.
Sebaceous carcinoma usually appears as a round, painless, and firm tumor that can involve either the upper or lower eyelid. Different types of growth occur in the eyelid. Of which, few can be benign in nature. A persistent growth that does not go away despite treatment is of concern and should be evaluated.
What Are the Other Names of Sebaceous Carcinoma?
-
Meibomian gland carcinoma (the sebaceous glands present on the eyelids are called meibomian glands, so cancer that involves the sebaceous glands of the eyelids is called meibomian gland carcinoma).
-
Sebaceous gland adenocarcinoma.
-
Sebaceous gland carcinoma.
What Causes Sebaceous Carcinoma?
Since sebaceous carcinoma is a rare type of cancer, the exact cause is unknown and still under research. However, when considering the most common sites of distribution of sebaceous carcinoma, which involves the head and neck region, it has been attributed that sunlight may play a significant role in causing this type of aggressive cancer.
What Increases the Risk of Developing Sebaceous Carcinoma?
The following risk factors increase the chances of developing sebaceous carcinoma:
-
Age: As far as sebaceous carcinoma is concerned, age is a significant risk factor, and this type of cancer can occur either early in life or at old age. In many cases, sebaceous carcinoma is diagnosed in people between the ages of 60 and 80. However, reports also suggest its occurrence in three-year-old children.
-
Race: Although discrepancies exist, it has been reported that sebaceous carcinoma is common among the Asian population.
-
Radiotherapy to the Head and Neck Region: Radiation treatments for cancers like retinoblastoma in children can predispose them to sebaceous carcinoma. Also, children who get radiation therapy during their childhood are prone to get sebaceous carcinoma in their later life, say at the age of 60 or 70 years.
-
Multi-Torre Syndrome: It is an autosomal dominant cancer syndrome that runs in families. This type of syndrome increases the risk of developing sebaceous carcinoma. Not only is it associated with sebaceous carcinoma, but also it can increase the chance of developing other types of cancer, colon cancer being the most common.
-
Immunocompromised Patients: A weakening of the immune system due to any of the below reasons increases the risk of developing sebaceous carcinoma:
- Drugs used in the treatment of arthritis or psoriasis.
- Immunosuppressant medications taken to prevent organ rejection following transplantation of organs.
- Immune deficiency diseases like cancer or human immunodeficiency virus (HIV).
How Is Sebaceous Carcinoma Manifested?
Manifestations of sebaceous carcinoma differ depending on the site. The following are the symptoms of sebaceous carcinoma when it occurs in the eyelid:
-
A slow-growing lump which occurs on the eyelid.
-
The swelling may be seen in either one or both eyelids.
-
The lump appears yellow in color, firm in nature, and is painless.
-
It usually occurs deeper.
-
In the area where the lids meet the eyelashes, there is thickening and the presence of yellowish or reddish crust.
-
The lump which occurs in the eyelid resembles a pimple.
-
Bleeding occurs from eyelid growth.
-
The lump present on the eyelid does not heal with treatment. In some cases, recurrence may occur after healing.
-
With progression, the eyes appear pinkish in color.
-
When the cancer lumps open up, oozing of fluid can occur.
-
In severe cases, eyesight may be affected.
The following are the symptoms of sebaceous carcinoma when it occurs beyond the eyelid:
-
Sebaceous carcinoma can occur anywhere in the body. Other common sites include the head and neck region, ear canal, genitals, chest, abdomen, back, and buttocks.
-
It appears as a slow-growing lump, which appears yellow or pink in color.
-
Bleeding can occur from the lump.
When Should I Reach Out to a Doctor?
The following signs are of concern which should be looked out for:
-
The appearance of new growth on the skin, eyelids, or the inner side of the ear.
-
Bleeding, rapid growth, or change in the appearance that occurs on the lump.
-
Changes in the appearance or size of a mole.
How Is Sebaceous Carcinoma Diagnosed?
Pagetoid spread, a vital hallmark diagnostic feature of sebaceous carcinoma, is the spread of malignant cells towards the epithelium, away from the primary tumor.
A comprehensive excisional biopsy is done on the primary lesion to bring about the diagnosis. After the diagnosis of sebaceous carcinoma is made, a biopsy is taken in the regional lymph nodes, if involved. Fine needle aspiration cytology is carried out by taking a sample with the help of a hollow needle. The sample is then histologically evaluated for the presence of malignant cells.
Distant metastasis of sebaceous carcinoma is identified with the help of a CT or MRI scan. In patients with Muir-Torre syndrome, early diagnosis for deep cancers is made using a Positron emission tomography (PET) scan.
How Is Sebaceous Carcinoma Treated?
Treatment for sebaceous carcinoma depends on the spread of cancer to other body parts and the involvement of lymph nodes.
1. Surgical Treatment:
The following two surgeries treat sebaceous carcinoma:
-
Excision - In this surgical procedure, the tumor along with healthy surrounding tissues is removed. This is done because even a healthy-looking tissue can contain few cancer cells, which can recur after some time.
-
Mohs Surgery - This surgical procedure is recommended for cancers involving the skin. The surgeon removes the entire tumor but only a tiny amount of tissue.
Cancer surgery involving the esthetic areas may require reconstructive surgery, either immediately or after recovery.
2. Radiation Therapy:
Although not the recommended way of treatment, radiation therapy is done in the following cases:
-
To reduce the pain when cancer has spread rapidly.
-
Patients who have undergone surgery to remove cancer still have a small amount of cancer left.
-
Patients who are not willing to undergo surgery or in whom surgery is contraindicated.
3. Cryotherapy:
In this procedure, the cancer cells are removed by exposing them to freezing temperatures.
What Is the Prognosis for Sebaceous Carcinoma?
Prognosis is good, and there is an increased survival rate with sebaceous carcinoma when the diagnosis is made early, and prompt treatment is sought.
Conclusion:
Any growth in the eyelids or head and neck regions should be evaluated with the help of a healthcare provider at the earliest to rule out the chances of sebaceous carcinoma. Since sebaceous carcinoma is an aggressive type of cancer, even after complete removal, regular check-ups are mandatory.
