What are sebaceous gland tumors?

Updated: Oct 07, 2019
  • Author: Guy J Petruzzelli, MD, PhD, MBA, FACS; Chief Editor: Gregory Gary Caputy, MD, PhD, FICS  more...
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Answer

Answer

Sebaceous gland tumors can vary from the benign (hyperplasia of the sebaceous gland) to the malignant (sebaceous carcinoma). Hyperplasia of the sebaceous gland often manifests in elderly persons and can be clinically mistaken for BCC.

Sebaceous hyperplasia

Sebaceous hyperplasia is a very common finding in Caucasians over age 50 years, particularly in those who have rosacea. It appears as yellow papules. Sebaceous hyperplasia can resemble BCC, fibrous papules, milia, and closed comedones. Treatment can be effected with trichloroacetic acid 20-30% or with curette and light electrodesiccation.

Benign sebaceous adenoma

Benign sebaceous adenomas are rare benign tumors. [109] Histologically, these lesions resemble sebaceous glands, and they must be distinguished from sebaceous hyperplasia. In contrast to the normal sebaceous gland, sebaceous adenomas contain lobular patterns that are irregular (see image below). In addition, the adenomas contain dark-staining basaloid cells, which surround lipid-containing cells that are smaller than the cells in the normal sebaceous gland. Surgical excision without wide margins is curative, and recurrence is extraordinarily rare.

Sebaceous Adenoma Sebaceous Adenoma

Sebaceoma

Troy and Ackerman defined the term sebaceoma as a benign neoplasm of basaloid cells with varying numbers of mature sebocytes. [110]

Carcinoma of the sebaceous gland

Clinical presentation and pathogenesis

Carcinomas of the sebaceous gland are rare malignant tumors that usually occur in the sebaceous glands of the eyelids, but they can also arise elsewhere on the head and neck. [111, 112] Case reports have described sebaceous carcinomas on the vulva. [113, 114]

This lesion is composed of lipid-containing cells that appear foamy and pale. Sudan IV staining confirms the presence of lipids in these foamy cells. The nuclei are pleomorphic and hyperchromatic. If the tumor is well differentiated, the lesion may contain a peripheral layer of dark-staining basaloid cells, resembling BCCs. The tumor typically spreads by direct extension.

Treatment

To minimize local recurrence, Snow and colleagues advocate Mohs surgery, especially in persons with evidence of intraepithelial spread. [115]

In addition, Cook and colleagues recommend conjunctival map biopsies, to assess whether or not the lesion has extended into the conjunctiva. [116]

The metastatic potential for sebaceous carcinoma is greatest when it occurs on the eyelids. The existence of sebaceous adenoma or carcinoma should raise the possibility of Muir-Torre syndrome, which can also be related to tumors of the intestines.

Local radiation treatment may be an alternative treatment, especially for patients who do not want surgery. [117]


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