Factors predictive of sebaceous gland carcinoma recurrence

This retrospective review identifies several risk factors for local recurrence or metastasis of sebaceous gland carcinoma (SGC). Using these risk factors will help you plan additional management, such as map biopsy of the bulbar and palpebral conjuctiva and simultaneous cryotherapy to remove potential residual pagetoid involvement. These findings may also help guide adjuvant treatment decisions regarding topical mitomycin C and systemic chemotherapy after delayed reconstruction.

Because no previous study directly investigated risk factors for local recurrence or metastasis of SGC solely after excision with pathologic management, the authors examined risk factors in only patients who underwent wide excision with paraffin section control. While detection of pagetoid lesions is better with paraffin sections compared with frozen sections, assurance of complete excision remains difficult.

Examining records from 34 patients who underwent wide excision with 5-mm surgical margins and paraffin section control, the authors identified the following risk factors for recurrence of metastasis (P<0.05, all):

• Involvement of both upper and lower eyelid;
• Previous topical treatment at other clinics;
• Multicentric origin;
• Diffuse pattern;
• Stage T3a; and
• Large tumor size and a nonlobular (poorly differentiated) pathologic pattern.

While the authors found pagetoid spread tends to affect the risk, this factor did not reach statistical significance (P=0.052). The authors also note that one patient who had no risk factors and clean margins experienced metastasis in the parathyroid gland. Based on this and a previous review, the authors suggest that map biopsies at the time of wide excision with paraffin section control may improve the reliability of complete excision, even in patients without risk factors.