Abstract ID: 26-627
High-Risk Sebaceous Carcinoma of the Upper Eyelid: A Diagnostic Masquerade with Perineural Invasion and an Adjuvant Treatment Dilemma
Author: Li Teng Kok Base Hospital / Institution: Queen’s Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, London
Presentation Type: ePoster Presentation
Purpose
Sebaceous carcinoma of the eyelid is a rare but aggressive oculoplastic malignancy, frequently masquerading as benign lid lesions. Delayed diagnosis is common, and high-risk histopathological features—including perineural invasion and deep tissue involvement—are associated with significant recurrence risk. Optimal management following complete excision remains controversial, particularly regarding the role of adjuvant radiotherapy. We present a high-risk case highlighting diagnostic delay, surgical reconstruction, and multidisciplinary (MDT) decision-making.
Methods
Case Report
Results
A middle-aged male presented with an enlarging lesion of the right upper eyelid involving the lateral lid margin and conjunctival surface, associated with intermittent bleeding and vascularisation. He underwent an excisional biopsy with full-thickness eyelid reconstruction using a Tenzel flap. Histopathology confirmed a poorly differentiated sebaceous carcinoma (pT3) with high risk features including full-thickness eyelid involvement and perineural invasion, although no lymphovascular invasion was identified. Recovery was uncomplicated with good functional and cosmetic outcome following reconstruction. Adjuvant radiotherapy was considered due to tumour stage and perineural invasion. However, due to complete excision with clear margins and concerns regarding potential morbidity to the ocular surface and surrounding, a consensus oncology MDT decision was made to proceed with active surveillance in line with skin oncology guidance.
Conclusion
Sebaceous carcinoma remains one of the most important malignant masqueraders in oculoplastic practice. Clinical resemblance to benign eyelid lesions often leads to delayed recognition. In the absence of universally accepted guidelines, treatment must be individualised through MDT collaboration. This case highlights the nuanced decision-making balance between oncologic control and functional preservation in periocular malignancy management.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Elifhazal | Livanturkoglu | Queen’s Hospital |
| Anna | Gkountelia | Queen’s Hospital |