Sebum carcinoma

Definition - What is sebum cancer?

A sebum carcinoma is a rare, but extremely aggressive, malignant tumor of the sebum glands. These glands are located in the skin or the eyelids and, with their secreted sebum, ensure part of the water tightness.
A distinction is therefore made between the more common ocular (located on the eye) and extraocular (affecting the rest of the body) form of sebum carcinoma. The more common ocular form occurs less often after removal, but has a significantly poorer prognosis.

Why is it common on the eyelid / eye?

There are special types of sebum glands around the eyes. On the one hand, these are the Zeis glands, which open into the hair follicle of the eyelashes, and, on the other hand, the meibomian glands, which open at the rear edge of the eyelid and are involved in the production of the tear film.
In addition, there are other sebum glands in the inner corner of the eye, the so-called lacrimal caruncle (tear ducts, which are located at the inner corner of the eye).
Ocular carcinoma of the sebum (located on the eye) is a degeneration of one of these types of glands, mostly the meibomian glands are affected.
The reason why sebum carcinoma occurs in about 75% of cases in the eye region is probably due to the fact that both the skin and the eyes come from a common tissue of origin (cotyledon) during embryonic development. This relationship is also evident in other skin diseases, such as B. Black skin cancer, which, in addition to its main manifestation in the skin, can also occur in the eye.
Read more on the topic: sebaceous gland

Causes of sebum carcinoma

When sebum carcinoma occurs in isolation and not with other cancers, its causes are largely unknown.
It is believed that radiation therapy e.g. B. as a result of an eye tumor such as retinoblastoma, sebum gland carcinoma. A connection with drugs that belong to the group of dehydrating drugs, so-called diuretics, are also suspected to be causal.
In addition, the sebum gland carcinoma can occur as part of a genetic disease, the Muir-Torre syndrome. In addition to degeneration of the sebum glands, tumors in the intestine, urinary tract, uterus in women and benign skin tumors occur.

Diagnosis of sebum carcinoma

The diagnosis is often made by a combination of the clinical picture and a tissue removal (biopsy). Conspicuous skin changes or eyelid swelling on the eye are examined with a light microscope (histologically).
If the suspicion of sebum carcinoma in the eye (ocular) or the rest of the body (extraocular) is confirmed in the tissue sample, computed tomography is usually carried out to assess the entire body or the eye socket and the adjacent structures. Thus, on the one hand, the spread of the tumor and, on the other hand, any existing metastases can be assessed.
Read more on the subject at: Eyelid tumor

These symptoms can be used to identify sebum carcinoma

Sick sebum carcinoma v. a. older people over 60 years. There is also a higher incidence of women and of Asian origin.
The extraocular shape (shape not affecting the eyes) usually occurs in the area of ​​the head and neck and appears as a raised area on the skin.
The eye-related (ocular) form occurs most frequently in the meibomian glands on the upper eyelid, as this is where most of the sebum glands are located. The sebum gland carcinoma almost always occurs on one side instead of on both sides. The tumor is firm and, due to its fat content, has a yellowish color. It is typically not painful and grows slowly. Loss of eyelashes can be observed in many cases.
In about a third of all sebum carcinomas, cells spread into the conjunctiva of the eye. This then appears red and swollen and does not respond to therapy. In addition, the lid is generally not swollen.
A sebum gland carcinoma of the eye can be mistaken for an inflammatory hailstone. In contrast, the hailstone occurs acutely, is painful and usually disappears again within a few weeks. If hailstones have been removed and grow back again, one should think of sebum gland carcinoma.
Another differential diagnosis is basal cell carcinoma, a special form of skin cancer that predominantly affects the lower eyelid.

Treatment and therapy of a sebum carcinoma

A sebum carcinoma cannot be treated conservatively or solely with medication. Due to the aggressiveness of the tumor, the treatment of choice is extensive surgical removal.
If lymph nodes are affected, they are also removed and the remaining tissue is irradiated here as well.
If the eye socket is also affected in the case of an advanced (ocular) sebum carcinoma, this is also removed as a whole. A glass eye can be used later if the patient so desires.
After the surgical removal of the tumor, radiation therapy is usually carried out. Since the tumor tends to grow back again at the removed site, regular clinical controls are necessary in order to be able to act early in case of doubt.
Read more on the subject under: Effect of radiation therapy and behavior during radiation therapy
In inoperable patients who e.g. Due to their poor general condition, they cannot be operated on, radiation can also be used as the primary, sole therapy. However, this then represents a palliative form of treatment; the goal is no longer to cure the disease but to alleviate the symptoms and improve quality of life.
Read more on the topic: Tumor - general therapeutic approaches and palliative therapy

The prognosis for sebum cancer

In up to 40% of cases, the tumor recurs at the remote site within the first few years after surgery. With ocular localization (on the eye), the risk is lower at 20%.
The sebum gland carcinoma is an extremely aggressively growing tumor that can rapidly form metastases (daughter tumors) with increasing size. Therefore the increasing tumor size is also a prognostically unfavorable parameter.
Other unfavorable factors are penetration of the tumor into vessels and appearance of the tumor in multiple places in the body. Furthermore, a slight differentiation of the cells in the tissue examination is to be regarded as unfavorable. This assesses how far the cells deviate from the cells of the original tissue.

Does sebum carcinoma metastasize?

In about a quarter of the cases, metastases develop in the course of the disease, which can be detected by means of computed tomography as part of the diagnosis of tumor spread. These almost always spread to the lymph nodes of the head and neck via the lymphatic drainage pathways.
Sometimes metastases are also found in the parotid gland. Metastasis via the blood to organs such as the liver, lungs or brain occurs rarely and only very late.
If there are metastases, the situation is generally inoperable and palliative therapy with radiation and chemotherapy is given.
Read more on the topic: Metastases and palliative therapy