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| CASE REPORT | | | Year : 2009 | Volume : 54 | Issue : 5 | Page : 43-45 | | | Primary sebaceous gland carcinoma of pinna | | | Akhilesh Kr Agarwal, Souradip Gupta, Sandipan Gupta, Gautam Guha
Department of Plastic Surgery Calcutta Medical College, Kolkata, India
Correspondence Address:
Akhilesh Kr Agarwal
C/O Mr. Ratan Pd. Agarwal, Shree Market, Station Road, Gonda - 271 002, UP
India
| |  Abstract | | | Sebaceous gland carcinoma is a rare cancer most commonly seen in the meibomian glands of the eyelid. It has predilection for periocular region and is rarely found in extra ocular sites. A case of sebaceous gland carcinoma over back of left pinna is reported.
Keywords: Meibomian gland carcinoma, pinna, sebaceous gland carcinoma
How to cite this article:
Agarwal AK, Gupta S, Gupta S, Guha G. Primary sebaceous gland carcinoma of pinna. Indian J Dermatol 2009;54:43-5 |
| Introduction | |  |
Sebaceous gland neoplasms can be adenomas, or carcinomas. Meibomian gland More Detailss are a type of sebaceous glands. The Meibomian glands of the upper eyelid are most commonly affected. [1],[2],[3],[4] The periocular tumor may involve the curuncle, the gland of Zeis, and in the eyebrows. [5]
The tumor is rare in extraocular sites [6] where it is found in anterior thorax, axillary skin, or other part of face. [7],[8] A few tumors have been found to be reported in external auditary canal. [9] One sebaceous gland carcinoma secondary to a sebaceous nevus in pinna has been reported. [9],[10] No report of primary sebaceous gland carcinoma has been found to be reported in previous literature. This case report adds sebaceous gland carcinoma to the differential diagnosis of pinna lesions and provides essential information about this rare mass.
| Case History | | |
A 32-year-old lady presented with an ulceroproliferative growth, over the back of the pinna, present since seven months. The lesion was of 4cm´3cm in size, fixed to underlying cartilage [Figure 1].
It was painless, and bled to minor trauma. No palpable neck node was present. Complete skin and ophthalamic examination was carried out.
The patient underwent an incisional biopsy from the margin of the lesion and diagnosis of sebaceous gland carcinoma was made.
Excision of growth was planned and patient was put for operation. The growth was excised with a margin of 1cm, including a part of conchal cartilage, a part of retro-auricular skin [Figure 2],[Figure 3]. The pinna was set back by suturing the incision margin of pinna with retroauricular incision margin [Figure 4].
Histopathology was consistent with the diagnosis of sebaceous gland carcinoma [Figure 5].
The patient is on regular monthly follow-up and no recurrence was noted over a year, till date [Figure 6].
| Discussion | | |
Sebaceous carcinoma is a rare aggressive tumor derived from the adnexal epithelium of sebaceous glands. The tumor is rarer in extraocular sites where fewer than 120 cases that have been reported so far.
An aggressive tumor in nature, the ocular tumor has a worse prognosis than its extra ocular counterpart and carries a commendable risk or metastasis and mortality.
The tumor is a lethal eyelid malignancy. It masquerades as benign conditions [11],[12] and hence the diagnosis is delayed. Tumors larger than 1cm are reported to have a greater mortality than smaller lesions. Tumors present for greater than six months have a mortality of 38%.
Patient evaluation includes a complete skin and ophthalmologic examination and palpation of nodes.
Incisional biopsy is required for diagnosis.
No specific imaging is required if the lesion is confined to pinna.
This malignancy is found to be associated with Muir-Torre syndrome. Family history for sebaceous neoplasms, keratoacanthomas, colorectal or genital malignancy should be sought.
Treatment is primarily surgical. [1] A resection margin of 0.5-0.6cm for primary tumors is advocated. Even then the tumor inocular sites recurres frequently and has high mortality. In our case large margin 1cm was excised as there is no definite treatment protocol.
The Mohs chemosurgery method commonly is used in facial and periocular nonmelanocytic malignancies. This method allows the focal and complete removal of a tumor with histologically verified margins. But in diffuse tumors with high recurrence rates as sebaceous gland carcinoma, recurrence rates may be as high with the Mohs chemosurgery method as with the traditional methods. Thus in histologically verified sebaceous gland carcinoma, wide complete (i.e., full thickness) resection is necessary.
Radiotherapy and chemotherapy have got very limited roles in management of this carcinoma.
| References | | |
| 1. | Khan JA, Doane JF, Grove AS Jr. Sebaceous and meibomian carcinomas of the eyelid: Recognition, diagnosis, and management. Ophthal Plast Reconstr Surg 1991;7:61-6.  [PUBMED] | | 2. | Gudas S. Skin cancer Rehabilitation Oncology, 2001. | | 3. | Dzubow LM. Sebaceous carcinoma of the eyelid: Treatment with Mohs surgery. JDSO 1985;11:40-4. | | 4. | Shields JA, Demirci H, Marr BP, Eagle RC, Shields CL. Sebaceous carcinoma of the eyelids: Personal experience with 60 cases. Ophthalmology 2004;111:2151. | | 5. | Awan KJ. Sebaceous carcinoma of the eyelid. Ann Ophthalmol 1977;9:608-10. [PUBMED] | | 6. | Glassman ML, Bashour M, Glassman ML. Opthal emedicine August 16, 2006. | | 7. | Omura NE, Collison DW, Perry AE, Myers LM. Sebaceous carcinoma in children. J Am Acad Dermatol 2002;47:950-3 [PUBMED] [FULLTEXT] | | 8. | Moreno C, Jacyk WK, Judd MJ, Requena L. Highly aggressive extraocular sebaceous carcinoma. Am J Dermatopathol 2001;23:450-5. | | 9. | Saito C, Nishioka K, Watanabe S, Masuda Y, Taguchi K. Sebaceous epithelioma in the external auditory meatus: A case report. Hiroshima J Med Sci 1991;40:79-81. [PUBMED] | | 10. | Misago N, Kodera H, Narisawa Y. Sebaceous carcinoma, trichoblastoma and sebaceoma with features of trichoblastoma in nevus sebaceous. Am J Dermatopathol 2001;23:456. [PUBMED] [FULLTEXT] | | 11. | Wagoner MD, Beyer CK, Gonder JR. Common presentations of sebaceous gland carcinoma of the eyelid. Ann Ophthalmol 1982;14:159-63. | | 12. | Brauninger GE, Hood CI, Worthen DM. Sebaceous carcinoma of lid margin masquerading as cutaneous horn. Arch Ophthalmol 1973;90:380-1. [PUBMED] |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6] | |
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