An 80-year-old male presents to clinic with a “bump” on his right upper eyelid. He says it has been present for approximately one year, and although not particularly bothersome to him he feels it may be enlarging. His medical and ocular history is otherwise unremarkable. On exam, a yellowish lesion is observed on the nasal aspect of the right upper lid, extending onto the palpebral conjunctiva (see image). The lesion is nontender and is fixed to the underlying tarsus. There are no palpable lymph nodes in the head or neck.
- To review the pathophysiology and clinical features of sebaceous carcinoma
- To review management options for sebaceous carcinoma
- To review the statistical concept of rank correlation
What is the most likely diagnosis?
A chalazion is a benign lesion of the eyelid occurring as a result of blockage to a meibomian gland or gland of Zeis. Although sebaceous carcinoma and chalazion are often confused, the lesion shown does not resemble a typical chalazion, and has features suggestive of a more sinister process.
Basal cell carcinoma
Basal cell carcinoma is the most common form of eyelid malignancy. Although it may be considered in the differential diagnosis of such a lesion, the yellowish color and extension onto the palpebral conjunctiva are more suggestive of the (rarer) sebaceous carcinoma.
Sebaceous hyperplasia is a relatively common condition that presents as yellowish or skin-coloured papules, most often on the face as opposed to the eyelids. The loss of cilia and extension onto the palpebral conjunctiva should prompt suspicion for an eyelid malignancy.
Sebaceous carcinoma (also known as sebaceous gland carcinoma or sebaceous cell carcinoma) is an uncommon malignancy that is most often found in the periorbital area, especially involving the eyelids.1 It accounts for less than 1% of all eyelid tumors, but is the second most common malignancy of the eyelids second only to basal cell carcinoma (90%). It accounts for roughly 5% of malignant eyelid lesions (squamous cell carcinoma accounts for 4% and other lesions such as melanoma make up the remaining 1%).2 Sebaceous carcinoma commonly masquerades as benign conditions such as chalazion, making it is notoriously difficult to diagnose, and easy to miss. Such diagnostic delay can often lead to poor patient outcomes. The tumor can be aggressive in nature, causing both local invasion as well as metastatic disease.
Sebaceous carcinoma is mostly a disease of elderly individuals, diagnosed at a mean age of 68.43 and rarely presents before the age of 60.1 It can occasionally be seen in younger individuals, most of whom have had previous irradiation to the eyelid area. It is also more common in females.