Indian Journal of Dermatology
CASE REPORT
Year
: 2009  |  Volume : 54  |  Issue : 5  |  Page : 43--45

Primary sebaceous gland carcinoma of pinna


Akhilesh Kr Agarwal, Souradip Gupta, Sandipan Gupta, Gautam Guha 
 Department of Plastic Surgery Calcutta Medical College, Kolkata, India

Correspondence Address:
Akhilesh Kr Agarwal
C/O Mr. Ratan Pd. Agarwal, Shree Market, Station Road, Gonda - 271 002, UP
India

Abstract

Sebaceous gland carcinoma is a rare cancer most commonly seen in the meibomian glands of the eyelid. It has predilection for periocular region and is rarely found in extra ocular sites. A case of sebaceous gland carcinoma over back of left pinna is reported.



How to cite this article:
Agarwal AK, Gupta S, Gupta S, Guha G. Primary sebaceous gland carcinoma of pinna.Indian J Dermatol 2009;54:43-45


How to cite this URL:
Agarwal AK, Gupta S, Gupta S, Guha G. Primary sebaceous gland carcinoma of pinna. Indian J Dermatol [serial online] 2009 [cited 2019 Nov 14 ];54:43-45
Available from: http://www.e-ijd.org/text.asp?2009/54/5/43/45443


Full Text

 Introduction



Sebaceous gland neoplasms can be adenomas, or carcinomas. Meibomian glands are a type of sebaceous glands. The Meibomian glands of the upper eyelid are most commonly affected. [1],[2],[3],[4] The periocular tumor may involve the curuncle, the gland of Zeis, and in the eyebrows. [5]

The tumor is rare in extraocular sites [6] where it is found in anterior thorax, axillary skin, or other part of face. [7],[8] A few tumors have been found to be reported in external auditary canal. [9] One sebaceous gland carcinoma secondary to a sebaceous nevus in pinna has been reported. [9],[10] No report of primary sebaceous gland carcinoma has been found to be reported in previous literature. This case report adds sebaceous gland carcinoma to the differential diagnosis of pinna lesions and provides essential information about this rare mass.

 Case History



A 32-year-old lady presented with an ulceroproliferative growth, over the back of the pinna, present since seven months. The lesion was of 4cm´3cm in size, fixed to underlying cartilage [Figure 1].

It was painless, and bled to minor trauma. No palpable neck node was present. Complete skin and ophthalamic examination was carried out.

The patient underwent an incisional biopsy from the margin of the lesion and diagnosis of sebaceous gland carcinoma was made.

Excision of growth was planned and patient was put for operation. The growth was excised with a margin of 1cm, including a part of conchal cartilage, a part of retro-auricular skin [Figure 2],[Figure 3]. The pinna was set back by suturing the incision margin of pinna with retroauricular incision margin [Figure 4].

Histopathology was consistent with the diagnosis of sebaceous gland carcinoma [Figure 5].

The patient is on regular monthly follow-up and no recurrence was noted over a year, till date [Figure 6].

 Discussion



Sebaceous carcinoma is a rare aggressive tumor derived from the adnexal epithelium of sebaceous glands. The tumor is rarer in extraocular sites where fewer than 120 cases that have been reported so far.

An aggressive tumor in nature, the ocular tumor has a worse prognosis than its extra ocular counterpart and carries a commendable risk or metastasis and mortality.

The tumor is a lethal eyelid malignancy. It masquerades as benign conditions [11],[12] and hence the diagnosis is delayed. Tumors larger than 1cm are reported to have a greater mortality than smaller lesions. Tumors present for greater than six months have a mortality of 38%.

Patient evaluation includes a complete skin and ophthalmologic examination and palpation of nodes.

Incisional biopsy is required for diagnosis.

No specific imaging is required if the lesion is confined to pinna.

This malignancy is found to be associated with Muir-Torre syndrome. Family history for sebaceous neoplasms, keratoacanthomas, colorectal or genital malignancy should be sought.

Treatment is primarily surgical. [1] A resection margin of 0.5-0.6cm for primary tumors is advocated. Even then the tumor inocular sites recurres frequently and has high mortality. In our case large margin 1cm was excised as there is no definite treatment protocol.

The Mohs chemosurgery method commonly is used in facial and periocular nonmelanocytic malignancies. This method allows the focal and complete removal of a tumor with histologically verified margins. But in diffuse tumors with high recurrence rates as sebaceous gland carcinoma, recurrence rates may be as high with the Mohs chemosurgery method as with the traditional methods. Thus in histologically verified sebaceous gland carcinoma, wide complete (i.e., full thickness) resection is necessary.

Radiotherapy and chemotherapy have got very limited roles in management of this carcinoma.

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