Treatment

The gold standard technique for sebaceous carcinoma treatment is complete circumferential peripheral and deep margin assessment and excision. Destructive techniques, such as electrodesiccation and curettage, are discouraged due to the propensity for relapse or metastasis.

The eyelid form is prone to recurrence and metastasis - Mohs micrographic surgery (MMS) shows lower recurrence and metastatic rates than wide local excision. (1)

MMS also ensures clear margins before reconstruction and proves particularly attractive in the treatment of this tumour, allowing for tissue conservation in cosmetically sensitive areas. (2)

Regional radiotherapy is preferred over complete node dissection in patients who have positive sentinel lymph node biopsy results, show evidence of nodal metastasis, or require palliative treatment. (3)

Mortality rates for sebaceous carcinoma vary widely, ranging from 9% to 50%, reflecting the heterogeneity of the disease and its management outcomes. Periocular sebaceous carcinoma exhibits recurrence rates ranging from 11% to 30%, with distant metastasis occurring in 3% to 25% of cases. (4)

Reference

1. Brady KL, Hurst EA. Sebaceous Carcinoma Treated With Mohs Micrographic Surgery. Dermatol Surg. 2017 Feb;43(2):281-286
2. Meer E et al. Sebaceous Carcinoma of the Face Treated With Mohs Micrographic Surgery. Dermatol Surg. 2022 Nov 01;48(11):1148-1154
3. Wilmas KM, Garner WB, Ballo MT, McGovern SL, MacFarlane DF. The role of radiation therapy in the management of cutaneous malignancies. Part II: When is radiation therapy indicated? J Am Acad Dermatol. 2021 Sep;85(3):551-562
4. Maloney NJ, Aasi SZ, Hirotsu KE, Zaba LC, Kibbi N. Positive surgical margins in sebaceous carcinoma: Risk factors and prognostic impact. J Am Acad Dermatol. 2023 Jul;89(1):184-185