Extraocular sebaceous carcinoma as a rapidly growing back ma
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Sebaceous carcinoma is a rare cutaneous tumor that is frequently located in the periorbital region and aggressive in nature. A 72-year-old man presented for evaluation of a progressively enlarging upper back mass. He had a past medical history of squamous cell carcinoma of the shoulder and basal cell carcinoma of the ear excised several years prior. The patient was in his usual state of health until eight months before presentation when he noticed a “pea sized” nodule on his back suspected at the time to be a sebaceous cyst. However, the mass gradually increased in size and started to bleed. As a result, he re-presented to the dermatology clinic 6 months later for assessment.

There had only been a slight increase in size, so he was scheduled for excision the following month. Increased bleeding and subsequent rapid growth in the interval month prompted an emergency department visit for expedited imaging. (MRI) revealed a 6.3×3.0×5.6cm soft tissue mass in the midline of his ower neck and upper back, approximately at the level of C7 through T1. The mass was composed of heterogeneous soft tissue with an internal area of necrosis and was noted to invade subcutaneous fat planes.

A 1.3×0.7cm enhancing lymph node was observed lateral to the mass, raising suspicion for regional nodal metastasis. On arrival for subsequent biopsy, the patient’s mass was fungating with bleeding at the surface and sensitivity to touch. He reported increased difficulty sleeping on his back and increased fatigue, but denied other constitutional symptoms. A biopsy of the mass was performed and showed a tumor with sebaceous features with vacuolated cytoplasm, confirmed by positive adipophilin immunostaining. The patient underwent staging (CT) of the chest, abdomen, and pelvis which did not suggest any evidence of metastatic disease. The patient underwent lymphoscintigraphy, subsequent sentinel lymph node biopsy(SLNB), and wide excision of the mass. The strongest signal was located in a right posterior shoulder node with an additional, weaker signal at the base of the left posterior neck.

Postoperatively the patient recovered well, but noted intermittent spasms of the left shoulder, possibly related to the proximity of his sentinel node to cranial nerve 11. However, he was able to shrug his shoulders symmetrically on exam and the spasms gradually resolved. At his most recent visit, now four months postoperatively, his examination and imaging showed no evidence of tumor recurrence.

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