Many sebaceous carcinomas (SC) develop on an eyelid, upper or lower.

The following are common things that may be noticed:

• Slowly growing, often yellowish lump on the eyelid that feels firm, deep and painless.
  
• Thickening of the eyelid where the lid meets the lash.
• Yellow or reddish crust on the eyelid where the lid meets the lash.
• Growth on the eyelid that looks like a pimple.
• Growth on the eyelid that bleeds.
• Sore on the eyelid that does not heal or heals and reappears.

To see the cancer, sometimes you have to pull gently on the eyelid to see the tumor. As the cancer progresses, it may look like pink eye.  The growths that develop may open and ooze fluid or bleed. Eyelashes may fall out. As the cancer grows, it can affect the eyesight.

SC is rare. Other growths that develop on the eyelid are much more common.

SC can be mistaken for some of these eye conditions:

• Stye: This common growth often looks like a pimple on the eyelid. Most styes are tender when touched while SC is painless. Without treatment, a stye can make the eyelid swell and make blinking painful. Most styes clear with treatment-warm compresses 4-6 times a day.
• Chalazion: This common condition causes the eyelid to become red and swell. Most chalazions clear with treatment- warm compresses and antibiotic eye drops.
• Pink eye or conjunctivitis: The white of the eye becomes red and can be painful. SC can look like pink eye that does not go away, even with treatment.

While SC is most common on the eyelid, it can occur elsewhere on the body. When SC develops elsewhere, it usually appears on the head or neck. SC has also been diagnosed on the genitals, ear canal, breasts and trunk of the body. In these areas, SC may look like a slowly growing pink or yellowish lump that may bleed.

If you see any of the following for more than 2 weeks, you should immediately make an appointment to see a dermatologist:

• New growth on your skin, eyelid or inside your ear
• A mole or other spot that begins to change

A growth or spot that starts to bleed, grow, or change in any way.

SC is rare, so scientists still have much to learn, including what causes it. Because most SCs develop on the head and neck, the sun may play a role in causing this skin cancer.

The most common risk factors for sebaceous carcinoma are as follows:

• Older age. Most people diagnosed with SC are between 60 and 80 years old
• Weakened immune system such as by medicines used in organ transplantation or those used to treat psoriasis or arthritis or medical conditions such as HIV or cancer
• Radiation treatments to the head or neck. People who received these radiation treatments in childhood have been diagnosed with SC in their 60s and 70s. SC also develops in children who receive radiation treatment for retinoblastoma, a type of eye cancer.
• Asian heritage
• Muir-Torre syndrome. This is a rare medical condition in which certain cancers such as colon cancer and SC are more common.

Diagnosis begins with a history and exam.  If your dermatologist suspects SC, be sure to tell your dermatologist if you have Muir-Torre syndrome (or if a family member has it), a transplanted organ, received radiation to the head or neck or taken a diuretic medication.

Your dermatologist will closely examine your skin looking for suspicious spots. When one is identified, a biopsy will be performed. The only way to diagnose sebaceous carcinoma (SC) is with a skin biopsy. Your dermatologist can perform this procedure during an office visit. In some instances, the dermatologist will refer you to an ophthalmologist for this purpose.

A skin biopsy should not cause anxiety. To perform a skin biopsy, your dermatologist will numb the suspected growth then remove part or all of it with a scalpel, punch or razor blade. Your dermatologist will send this to a laboratory to be looked at under a microscope. The findings will be communicated in a biopsy report.

If you are diagnosed with SC, your doctors will want to know if the cancer has spread to the lymph nodes or other parts of the body. You will need:

• A thorough physical exam including lymph node exam
• A thorough eye exam
• Other medical tests which may include a colonoscopy, blood tests,  chest x-ray and CT scans
• Lymph node biopsy if an enlarged lymph gland is identified
• Most patients diagnosed with SC are treated with surgery.  Two types of surgery are used:
• Excision. This may be performed by the dermatologist or ophthalmologist.  It involves numbing the area to be treated and cutting out any remaining tumor. Like the skin biopsy, this removed skin is examined under a microscope to ensure that the entire tumor has been removed.
• Mohs micrographic surgery. Named for the doctor who developed this surgery, Mohs (pronounced moes) is a surgery performed by a specialist to remove certain skin cancers. This surgery gives a high cure rate and limits the amount of normal skin that has to be removed around the cancer. Because many SC develop on the eyelid, this tissue-sparing surgery may be recommended. Your dermatologist will tell you if Mohs is right for you.  With Mohs surgery, the surgeon will cut out the tumor plus a small amount of normal-looking skin surrounding the tumor. While you wait, the Mohs surgeon uses a microscope to determine if there are left over cancer cells. If cancer cells remain, the surgeon will continue to remove small amounts of skin and look at them under the microscope. This continues until the surgeon no longer sees cancer cells. After the cancer surgery, some patients need reconstructive surgery which can be performed immediately after the cancer is completely removed.

Other treatments may include:

• Lymph node dissection: When SC spreads to the lymph nodes, the patient may have surgery to remove the affected lymph nodes.
• Radiation treatments: Radiation is not the first choice for treating SC but may be an option for easing pain if the cancer has spread, treating patients who refuse or cannot undergo surgery or treating patients who have had surgery but may still have some cancer left.

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