Purpose

To report a rare case of sebaceoma arising from the tarsal conjunctiva in an immunosuppressed patient and to highlight diagnostic challenges and the importance of early histopathological evaluation.

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Methods

A 67-year-old man with a history of renal and pancreatic transplantation, maintained on mycophenolate mofetil and sirolimus, presented with a rapidly enlarging, firm, white, non-tender lesion measuring 8 × 6 × 3 mm on the left lower tarsal conjunctiva over four weeks. Initial treatment with topical Maxitrol was ineffective. An excisional biopsy was performed, followed by histopathological and immunohistochemical analysis.

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Results

Histopathology demonstrated a sebaceous neoplasm composed of basaloid cells with admixed mature sebocyte-type cells, consistent with sebaceoma. Sebaceomas are rare, accounting for approximately 1.6% of sebaceous neoplasms, with only five previously reported cases involving the eyelid and exceedingly few arising from the tarsal conjunctiva. Although sebaceomas have been associated with Muir–Torre syndrome, immunohistochemical testing for relevant markers in this case was negative. A comprehensive genetic malignancy panel is pending.

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Conclusion

Sebaceoma of the tarsal conjunctiva is exceptionally rare and may clinically mimic benign or malignant eyelid lesions, leading to diagnostic delay. Rapid growth, immunosuppression, and potential association with systemic malignancies underscore the need for early biopsy and histological confirmation. Awareness of this entity is essential to ensure timely diagnosis and appropriate systemic evaluation.

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Additional Authors

First name	Last name	Base Hospital / Institution
Connie	Han	Milton Keynes University Hospital
Jennifer	Doyle	Milton Keynes University Hospital

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