Sebaceous gland carcinoma: Can we do better?
The present article has been published as an editorial in the Indian Journal of Ophthalmology.

Sebaceous gland carcinoma (SGCa) is the most common eyelid malignancy in India. Yet, it is widely misdiagnosed and mismanaged. Delayed diagnosis and inappropriate treatment, coupled with the inherent aggressive behavior of the tumor, result in an unacceptably high incidence of local recurrence, regional lymph node metastasis, systemic metastasis, and death.

In an era of advanced imaging, precise microsurgery, powerful chemotherapeutic protocols, and stereotactic radiotherapy, steered by well-trained ocular oncologists and ophthalmic oncopathologists, we can certainly do better.

Over 50% of patients with nodular SGCa simulate a chalazion and those with intraepithelial (pagetoid) SGCa masquerade as unilateral blepharoconjunctivitis. General ophthalmologists, being the primary point of contact, must be well aware of the clinical signs of SGCa and the red flags that tip the diagnosis.

Apart from an obvious eyelid nodule extending beyond the upper edge of the tarsus (unlike a chalazion, which is limited to the tarsus), the nodular type of SGCa typically manifests with loss of eyelashes in the involved area, loss or obliteration of Meibomian gland More Details orifices, widening of the eyelid margin, abnormal vascularity of the eyelid margin, and alteration in the sharp anatomy of the posterior eyelid margin (rounding).

SGCa is clearly not a tumor that a general ophthalmologist or an occasional oculoplastic surgeon may be able to comprehensively manage. A general ophthalmologist should be aware of the clinical manifestations of SGCa and be able to triage a suspected case quickly to an appropriate specialist.

SGCa is ideally managed strictly by the protocol by a trained oculoplasty surgeon with special interest in and understanding of ocular oncology or by an ocular oncologist. Optimal combination of clinical and surgical skills, guided by sound oncological principles, could provide the best chance for local and regional tumor control and minimize metastasis and death in SGCa.

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