Sebaceous Carcinoma: A Case Study on Diagnosis and Treatment
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This case study describes a 75 year old patient with sebaceous carcinoma on the cheek. The patient presented with a hyperkeratotic papule that was diagnosed as sebaceous carcinoma through skin examination and biopsy. Treatment options include surgery and radiation therapy.
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SEBACEOUS CARCINOMA NAME INSTITUTION TUTOR DATE
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ABSTRACT Objective:To describe the case of sebaceous carcinoma in a 75 year old patient who presented with a swelling on the cheek. Case summary:The case study was on a 75 year old man who presented with a hyperkeratotic papule on the left cheek with keratin core that had been present for six months. Perioperative diagnosis on the skin of the left zygoma indicated sebaceous carcinoma. Histologic sections indicated skin with unremarkable epidermis. There was also proliferation of the sebaceous lobules which had basaloid keratinocytes at the periphery and it showed sebaceous differentiation at their centers. A subset of the neoplastic cells show mature sebaceous differentiation. On immunohistochemistry, the tumor cells expressed nuclear factor XIIIa, EMA and P63 and they were negative for CK20. Discussion:Sebaceous carcinoma develop in any sebaceous gland whose function is lubricating the skin. However, it mostly begins around the eyelids. In this case study, the cancer developed at the left cheek of the patient and this is why this case was of particular interest. This type of cancer if diagnosed early and treated, it is usually successful but can turn out to be deadly if spreads rapidly. This type of cancer sometimes appear in the form of a sty and that is why majority delay the diagnosis and this leads to death .It is therefore important that one makes an appointment whenever they note any growth or swelling on the eye. Conclusion:Sebaceous carcinoma is a very type of skin cancer that mostly attacks the eyelids leading to swelling. It can be diagnosed through skin examination as well as microscopic examination of biopsies that reveal certain features. Treatment is either through surgery or Mohr surgery and radiotherapy.
INTRODUCTION Sebaceous carcinoma is a type of skin cancer. This condition is however very rare. It is sometimes known as aggressive sebaceous carcinoma due to its ability to spread. It mostly attack the eyelids. This form of cancer usually begin as a form lump on the eyelids1.As the cancer proceeds, there is bleeding or oozing from the eyelids. When it occurs on other parts of the body, the appearance is usually yellowish lumps which may also bleed2. In this assignment, there will be description of a case study in which a patient was suffering from sebaceous carcinoma. 1A Acosta et al, (2018)Sebaceous carcinoma of the breast in a patient with a pathogenic BRCA2 (886delGT) mutation - focus on histopathologic and immunohistochemical features.APMIS,126(4), 353-356.doi:10.1111/apm.12826 2J Brewer et al, (2016).Effect of Non-Hodgkin Lymphoma on Survival in Patients With Malignant Fibrous Histiocytoma, Kaposi Sarcoma, and Sebaceous Carcinoma.Dermatologic Surgery,42, S32- S39. doi:10.1097/dss.0000000000000520
CASE REPORT The case involved a 75 year old man who presented with a spot on his cheek. He had a medical history of Non melanoma skin cancer and presented with a rapidly growing papule on lzygoma. He also had a Squamous Cell Carcinoma in Situ on his nose which was diagnosed by punch biopsy. He has also suffered from invasive Squamous Cell Carcinoma of Left temple that was treated by shave excision without indications of margins in September 2017.Up to date, there has been no recurrence. The patient also had a rapidly growing nodule on his left cheek for 4 weeks which has crusted but is yet to become tender. On review of systems, it was established that the patient had no fever, chills, cough or any oral lesions .The patients past medical history
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as well as social history, medications and any allergies were as well reviewed. It was established that the patient’s family history has no contribution. On physical exam the patient was well developed and well-nourished with no acute distress. On skin examination ,the scalp had an ill- defined erythematous macules that had overlying adherent scales on the scalp .The face had an ill-defined erythematous macules that had an overlying adhering scales on the forehead .There was also a crust nodule that had keratin core on Lzygoma. The lips were normal as well as the ears, the neck and the chest .The abdomen was also normal the assessment and plan included neoplasm of uncertain behavior, zygoma .It was suspected to be Keratoacanthoma type Squamous cell Carcinoma. After discussion on risks such as pain, bleeding, infection, recurrence and scarring, consent was then obtained. The biopsy site was then adequately prepared using alcohol, allowed to dry and then as infiltrated with 1% lidocaine with epinephrine .A shave biopsy was then obtained using Derma blade /15 and the specimen taken to dernatopathology. For purposes of maintaining hemostasis, Aluminum chloride was used. Antibiotic ointment and clean dressing were also applied .The patient responded well to all the procedures. However, both verbal and written wound care instructions were provided to the patient. The Actinic keratosis which 5 of them were destroyed using liquid nitrogen cryotherapy. The patient also tolerated to this procedure very well. The patient was to return to the clinic after 6 months. The final diagnosis of skin left zygoma and shave biopsy indicated sebaceous carcinoma. There was a plan to send the patient for Mohs and this was also discussed colonoscopy since this was associated with Muir Torre syndrome. The patient was given the information and he was to get with his PCP for colonoscopy because he has had that done 5 years ago. The patient was informed about the sebaceous carcinoma and was therefore referred to Mohs. He was prescribed aspirin which he stopped 7 days prior to the procedure.
The patient presented in clinic for Mohs micrographic surgery on the left cheek which has been present for 6 months. The whole process was explained to the patient together with the consequences. The Hibiclens scrub to the entire region was then performed. Anesthesia was infiltrated while the patient was comfortably positioned. The apparent residual tumor was debulked so as to obtain the best histology with minimal defects. After surgery, the biopsy was then observed microscopically and the sections showed skin with unremarkable epidermis within the dermis. There was also proliferation of sebaceous lobules that had basaloid keratinocytes at the periphery and this indicate sebaceous differentiation in their centers. Neoplastic cells showed mature sebaceous differentiation. Majority of mitosis were seen and there was nuclear atypia. Overall, architectural growth was minimal infiltrative. On immunohistochemistry, the tumor cells expressed nuclear factor XIIIa, EMA and finally P63 were all negative for the CK20 as well neurofilament .Sebaceous neoplasms are mostly associated with the Muir- Torres syndrome. DISCUSSION Sebaceous carcinoma is a rare cancer that often attack the eyelids and cause swelling. There are different methods that can be used to diagnose sebaceous carcinoma3.This was particular case study was of particular interest since unlike many other sebaceous carcinomas that develop at the eyelids, this was one was at the left cheek. The most common methods include skin examination for reddening. An eye examination can also be carried out to check if the eyelids are swollen4.The final method that can be used to diagnose the condition is skin biopsy. This involves removing a small portion of tissue for further testing. 3Robert Kyllo,keegan Brady & Einsten Hurst, (2015).Sebaceous Carcinoma.Dermatologic Surgery,41(1), 1-15. doi:10.1097/dss.0000000000000152 4J North et al,(2018)Cell of origin and mutation pattern define three clinically distinct classes of Sebaceous carcinoma.Nature Communications,9(1). doi:10.1038/s41467-018-04008-y
There are different treatment options for sebaceous carcinoma. The treatment options in most cases involve surgery to remove the cancer.5This involves excisional surgery together with a normal margin of the tissue. Another treatment option is the Mohs surgery. This is a type of surgery that involve progressive removal of layers that are affected by cancer until only the healthy layers remain. Other treatment options include radiation therapy whereby strong beams of energy like X-rays are used to kill the cancerous cells. CONCLUSION Survival from sebaceous carcinoma lies in how early the condition is diagnosed. Studies have reported increased survival rates among those patients who were diagnosed early. The methods of diagnosis include skin examination and microscopic examination of biopsies obtained through the normal incision surgery or the Mohs Surgery. The latter are also the methods of treating the cancer. Even though this cancer is very rare, there should be immediate diagnosis the moment one notes a sty or any form of swelling on their eyes. From this case study, 5S Rubin et al, (2018). Prognostic factors for local recurrence, metastasis and survival for sebaceous Carcinoma of the eyelid: observations in 100 patients.British Journal of Ophthalmology, Bjophthalmol-2018-312635. doi:10.1136/bjophthalmol-2018-312635
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it is apparently clear that sebaceous carcinoma does not necessarily arise from the eyelids but at other locations like the cheek. Bibliography
Articles Acosta,A.M., Al Rasheed,M.R., Xu,H., Salibay,C., & Pins,M.R. (2018). Sebaceous Carcinoma of the breast in a patient with a pathogenic BRCA2 (886delGT) mutation - focus On histopathologic and immunohistochemical features.APMIS,126(4), 353-356. doi:10.1111/apm.12826 Brewer,J.D., Shana felt,T.D., Cerhan,J.R., Call,T.G., Weaver,A.L., & Otley,C.C. (2016). Effect of Non-Hodgkin Lymphoma on Survival in Patients With Malignant Fibrous Histiocytoma, Kaposi Sarcoma, and Sebaceous Carcinoma.Dermatologic Surgery,42, S32- S39. doi:10.1097/dss.0000000000000520 Kyllo,R.L., Brady,K.L., & Hurst,E.A. (2015). Sebaceous Carcinoma.Dermatologic Surgery,41(1), 1-15. doi:10.1097/dss.0000000000000152 North,J.P., Golovato,J., Vaske,C.J., Sanborn,J.Z., Nguyen,A., Wu,W., … Cho,R.J. (2018). Cell of origin and mutation pattern define three clinically distinct classes of sebaceous carcinoma.Nature Communications,9(1). doi:10.1038/s41467-018-04008-y Sa,H., Rubin,M.L., Xu,S., Ning,J., Tetzlaff,M., Sagiv,O., … Esmaeli,B. (2018). Prognostic factors for local recurrence, metastasis and survival for sebaceous carcinoma of the eyelid: observations in 100 patients.British Journal of Ophthalmology, bjophthalmol-2018-312635. doi:10.1136/bjophthalmol-2018-312635