Sebaceous Cell Carcinoma: Wide Histological Spectrum and Correlation to Prognosis. A Case Report and Review of the Literature

Sebaceous cell carcinoma (SCC) is the second most common eyelid malignancy among Caucasians, next to Basal cell carcinoma (BCC). It is an uncommon malignant neoplasm, and there are several reports describing the multiple clinical and histopathological presentations of SCC. Given its rarity, diagnosing SCC remains a challenge for ophthalmologists and pathologists, especially when conducting incisional biopsies. A 66-year-old male presented with a recurrent right upper eyelid mass for 4 years. The lesion recurred 4 times, and a biopsy was performed twice. In the first biopsy, a mild cell atypia was observed; the second biopsy was negative for atypia or cancerous cells. The patient was followed-up closely and in the 4th recurrence, a full thickness biopsy was performed. Histopathologically, areas of well-differentiated SCC were observed, as well areas of poorly differentiated SCC resembling BCC, squamous cell carcinoma in situ, and mucoepidermoid carcinoma. We highly recommend clinical and pathological suspicion of SCC in clinical cases of recurrent chalazion, treatment-resistant blepharoconjunctivitis, and undifferentiated malignant tumors of the eyelid present late in life.