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A 73-year-old man is referred for evaluation of several skin lesions. The patient’s medical history is significant for a kidney transplant and he is taking multiple medications including mycophenolate mofetil. He has no prior history of skin cancer. Examination reveals multiple seborrheic keratoses on his trunk as well as scattered facial papules. A raised 0.6 cm whitish nodule adjacent to the right nasolabial crease is biopsied. He states that he noticed this growth approximately 2 months ago.
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Biopsy of the lesion reveals a sebaceous carcinoma prompting referral to a surgical oncologist. Sebaceous carcinoma is an uncommonly encountered malignancy with a predilection for the face. A majority of cases arise on the eyelid or periorbital region.1 Case reports document rare occurrences on the extremities and genitalia.2 Sebaceous carcinoma typically presents as a discrete papule or nodule ranging in coloration from pink to off-white. Histology reveals a predominately dermal tumor composed of lobules of basaloid cells with cytologic atypia and evidence of sebaceous differentiation, which may be difficult to discern in high-grade tumors.3 Some pathologies may resemble metastatic renal or prostate carcinoma.
Sebaceous carcinoma is an aggressive neoplasm that most commonly affects elderly patients. Early treatment is necessary to prevent metastatic spread and a sentinel lymph node biopsy and further imaging studies may be indicated for larger tumors.4 Wide excision or Mohs micrographic surgery are treatments of choice. Inoperable tumors may respond to radiation therapy.5 A retrospective analysis of over 1300 cases revealed a 5-year survival rate under 70% for extraocular sebaceous carcinoma.6
Brittany Spinosa-Weber, PA-C, is on staff of DermDox Centers of Dermatology in Bethlehem and Sugarloaf, Pennsylvania. Stephen Schleicher, MD, is director of the DermDox Dermatology Centers, associate professor of medicine at Geisinger Commonwealth Medical College, and clinical instructor of dermatology at Arcadia University and Kings College.
References
1. Shields JA, Demirci H, Marr BP, Eagle RCJr, Shields CL. Sebaceous carcinoma of the eyelids: personal experience with 60 cases. Ophthalmology. 2004;111(12):2151-2157. doi:10.1016/j.ophtha.2004.07.031.
2. Candelario NM, Sanchez JE, Sanchez JL, Martin-Garcia RF, Rochet NM. Extraocular sebaceous carcinoma — a clinicopathologic reassessment. Am J Dermatopathol. 2016;38(11):809-812. doi:10.1097/DAD.0000000000000591
3. Danialan R, Mutyambizi K, Aung P, Prieto VG, Ivan D. Challenges in the diagnosis of cutaneous adnexal tumours. J Clin Pathol. 2015;68(12):992-1002. doi: 10.1136/jclinpath-2015-203228
4. Knackstedt T, Samie FH. Sebaceous carcinoma: a review of the scientific literature. Curr Treat Options Oncol. 2017;18(8):47. doi:10.1007/s11864-017-0490-0
5. Owen JL, Kibbi N, Worley B, et al. Sebaceous carcinoma: evidence-based clinical practice guidelines. Lancet Oncol. 2019;20(12):e699-e714. doi:10.1016/S1470-2045(19)30673-4
6. Dasgupta T, Wilson LD, Yu JB. A retrospective review of 1349 cases of sebaceous carcinoma. Cancer. 2009;115:158-165. doi:10.1002/cncr.23952
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