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Answers: 2008 Series -  September 23, 2008 Lecture 15 of 53  NEXT»

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Case15A
Figure 1
Case15B
Figure 2

Photos courtesy of: Carol L. Shields, M.D.
Used with permission. Not to be reproduced.

A 56-year-old male complained of chronic irritation in his left eye for the past 2 years. He was treated for blepharitis and chronic conjunctivitis with intermittent relief. His best visual acuity was 20/20 in both eyes. The right eye was within normal limits. The left upper eyelid was thickened and edematous, with papillary reaction on tarsus, which was extending unto the lateral canthal region as shown above. The rest of the examination was normal in the left eye.

1. What is the presumptive diagnosis?

a -- sebaceous gland carcinoma

2. What is the best way to manage to this case?

d -- wide excision of the lesion and map biopsy


Chronic history and diffuse, unilateral blepharoconjunctivitis (clearer in figure 2) in an older age group is nearly always suggestive of diffuse sebaceous gland carcinoma of the eyelid, unless proven otherwise.  If well localized, wide excision with lid reconstruction can be done. For extensive lesions proven on map biopsy, treatment has to be titrated according to the depth and extent of involvement. It might need only supplemental cryotherapy or even, an exenteration.

 

REFERENCES: 

1.  Shields JA, Demirci H, marr BP, et al. Sebaceous Gland carcinoma of the eyelids.
     Personal experience with 60 cases. Ophthalmology 2004: 111; 2151- 2157.


2.  Honavar S, Shields CL, Shields JA, et al. Primary intra-epithelial sebaceous gland
     carcinoma of palpebral conjunctiva. Arch Ophthalmol 2001: 119; 764-767.

 



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