BACKGROUND: Sebaceous carcinoma (SC) most commonly presents on the eyelid and is frequently misdiagnosed both clinically and pathologically. Only very rare cases of desmoplastic tricholemmoma (DTL) of the eyelid have been reported. Methods: We present a case of DTL of the eyelid initially misdiagnosed as an invasive SC. RESULTS: A 55-year-old man presented with a rapidly growing 5 mm erythematous lesion on his upper eyelid. Histologic examination showed a lobular, folliculocentric proliferation of palely eosinophilic to clear cells surrounded by peripheral basal cells with palisading. The central portion of the lesion appeared infiltrative with clear cells surrounded by a thickened basement embedded in a dense, collagenous stroma. However, the cells showed mostly uniform cytoplasmic clearing, lacking the multivacuolization or nuclear scalloping of sebocytes. In addition, a periodic acid Schiff stain was positive with diastase sensitivity, indicating cytoplasmic glycogen, not lipid. CD34 immunohistochemical staining was also positive, which has been reported in DTL but not in SC. CONCLUSIONS: SC is often misdiagnosed as other entities, but misidentification of other neoplasms as SC is less common; however, this is an important diagnostic pitfall, as it may result in unnecessary and disfiguring surgical treatment and consequent medical-legal liability. Therefore, DTL should enter the differential diagnosis of clear-cell neoplasms on the eyelid.

Sebaceous carcinoma of the eyelids: a review of 21 cases. J Plast Reconstr Aesthet Surg. 2007 Oct 30.

BACKGROUND: Sebaceous carcinoma is a malignant neoplasm that arises from the sebaceous glands and occurs most often in the eyelids. A tumour diameter exceeding 10mm indicates a grave prognosis. However, thus far, no study has used the T classification of the tumour, node, metastasis (TNM) staging system to determine the prognosis. In this article, we studied the management and outcomes of sebaceous carcinoma using the T classification. METHODS: We report our experience of sebaceous carcinoma of the eyelids in 21 patients between December 1979 and December 2003. We employed the method of T classification and assessed the management and clinical outcomes in patients with sebaceous carcinoma of the eyelids. RESULTS: The sample included three T1, six T2, five T3, and seven T4 cases. All the cases were managed by surgery. The follow-up periods ranged from 22 to 123 months. The mean and the median were 70.7 and 62 months, respectively. At the time of the last follow up, 12 of the 21 patients were alive. Five deaths were secondary to the tumour and four were unrelated. Most importantly, none of the T1, T2, or T3 patient deaths were secondary to the tumour. However, all the patients that died as a result of the tumour were of the T4 type. The cause-specific cumulative survival rate over five years was 78.9%; however, that of the T4 type was 42.9%. CONCLUSION: None of the T1, T2, or T3 patients died as a result of the tumour, which indicates a good prognosis. However, the cases of the T4 type had a grave prognosis. Therefore, the T classification alone may be an important factor in determining the prognosis for sebaceous carcinoma of the eyelids.