Sebaceous Carcinoma of the Nose

Case Description

We present a case of sebaceous carcinoma (SC) in an uncommon location, the nose. Our patient was a 71-year-old, retired, white male who presented with a 3-month history of a nonhealing lesion on his right nostril. His past medical history was positive for Crohn disease treated with 6-mercaptopurine for 4 years, hypertension (taking atenolol and lisinopril), and peptic ulcer disease. Physical examination revealed a 2.0-cm erosion on the floor of the nostril with extension to the free margin of the ala and columella. Shave biopsy was preformed, and histopathological examination revealed an irritated and inflamed squamous cell carcinoma (SCC). All treatment options were discussed, and the patient elected to proceed with radiation. The patient underwent 33 fractions of radiotherapy over a span of 3 months. Two months following radiation, the patient developed pain and erythema of the nasal tip. Culture and sensitivity returned heavy growth of Pseudomonas aeruginosa and Klebsiella oxytoca. He was diagnosed with soft tissue cellulitis and treated with ciprofloxacin, mupirocin ointment, and ketorolac. Two weeks later, he developed central facial erythema and ulceration of the right nasal cavity. Shave biopsy revealed an asymmetric, infiltrating aggregation of mature and immature neoplastic sebocytes with pleomorphism, hyperchromatic irregular nuclei, and mitoses (Figs 1 and 2). Immunohistochemistry revealed positive adipophilin and epithelial membrane antigen (EMA) (Figs 3 and 4, respectively). The patient was diagnosed with poorly differentiated SC. The patient underwent radical excision of a 2.4 × 1.8 × 1.2-cm poorly differentiated SC with lymphovascular and perineural invasion. The patient remains in the care of a maxillofacial prosthodontist and a plastic surgeon for osseointegrated implants and nasal prosthesis.

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