Treatment and outcomes for metastatic sebaceous cell carcinoma of the eyelid

Objective: To report the management and outcomes in patients with metastatic eyelid sebaceous cell carcinoma. Methods: The clinical records of four patients with metastatic eyelid sebaceous cell carcinoma treated between January 1999 and August 2006 were reviewed. Results: The study included four women with a mean age of 66 years. Metastatic sites included the lung in three patients, regional lymph nodes in two, liver in two, and bone in one. Time from diagnosis of eyelid carcinoma to metastasis ranged from 0 to 62 months. Treatment of regional nodal metastasis consisted of complete neck dissection followed by radiation therapy. One patient developed lung metastasis 5 years after the diagnosis of eyelid tumor; she was treated with systemic chemotherapy followed by subtotal lung resection. Systemic chemotherapy was considered for two additional patients: in one, chemotherapy was deferred due to poor performance status and ongoing medical problems; and another patient died before chemotherapy could be started. The patient with bony metastasis was treated with radiation therapy to the spine. Two patients died during the study period. The follow-up time from diagnosis of metastasis to last contact or death ranged from 1 month to 3 years (median of 21 months). Conclusion: Eyelid sebaceous cell carcinoma can result in systemic metastasis and death. Metastasis can be discovered as late as 5 years after treatment of the eyelid carcinoma, warranting continued surveillance. Treatment of metastatic disease may include a combination of chemotherapy, radiation, and surgical neck dissection.