VIMS Journal: December 2016

Case Report

A Rare Case Report of Sebaceous GlandCarcinoma of Posterior Aspect of Left Arm

Dr S. M. Bhattacharya , Dr. Nanigopal Bhattachyarya , Dr. Tanusree Kundu

Key Words :
Sebaceous Gland , Carcinoma , Arm

Introduction :
Sebaceous carcinoma (SC) is uncommon diseasethat is often misdiagnosed as a benign lesion,but has an aggressive clinical behavior with arate of distant metastasis of nearly 60% [1] .There are two main variants on the basis of theirlocation; ocular and extraocular SC. ExtraocularSC accounts for only about 25% of all SC, andmostly involves the head and neck region,although it may occur at any site that containssebaceous glands, including the trunk, extremities,and the external genitalia [2,3] . To our knowledge,SC on the extremities is very rare. Here in, wereport a case of sebaceous carcinoma on the leftarm of an Indian female.

Case History :
A 50 year old female patient presented with aswelling in the back of left forearm of one yearduration.

On Examination :
A 2.5 * 3 cm mobile lump in the back of leftarm which is fixed to the overlying skin.

Figure-1



Figure-2



Figure-3



Diagnosis :
Sebaceous cyst by clinical examination.
Operative Procedure :
Excision of the cyst under local anaesthesia.

Histopathological Examination :
Malignant adnexal tumor-sebaceous glandcarcinoma with involvement of the deep resectedmargin.
Subsequently deep plane excision was doneincluding the previous skin incision and thespecimen was send for histopathologicalexamination.{as shown in figures 1,2.3}

Figure-4



Figure-5



Figure-6



Histopathological Examination :
1. No evidence of any residual malignancy wasfound.
2. All margins and deep planes are free. [Asshown in figure 4,5,6]

Discussion :
Definition :

- Sebaceous Carcinoma of Skin is a very rare,malignant tumor of the skin, arising fromthe sebaceous gland. They are thought tooccur due to sun damage.
- Common locations where the tumor isobserved is the head and neck region,apartfrom the trunk, arms and legs.
- However, the tumors are most frequentlyseen on the eyelids and hence the termMeibomian Gland Carcinoma is used toindicate the condition.
- For some unknown reasons, individuals ofAsian origin seem to be affected bySebaceous Carcinomas more than individualsof any other race or ethnic group.
- The treatment of choice for this malignantskin tumor is surgical intervention; however,there is a chance of recurrence. The prognosisis poor for metastatic Sebaceous GlandCarcinomas

Age and Sex Distribution :
- Sebaceous Carcinoma of Skin is usually seenin adults, in their 60s. However, the conditionmay affect individuals of any age.
- It is predominantly found in females; thefemale-to-male ratio is 2:1
- Sebaceous Gland Carcinoma is more commonin certain Asian countries, such as in India.

Predisposing Factors :
The risk factors of Sebaceous Carcinoma ofSkin include:
- Any occupation that increases sun exposure,such as farming or construction, is a riskfactor.
- Radiation therapy to a region increases thechances of Sebaceous Carcinoma in the regionof the radiation (in the future).
- Individuals with a weak immune system, dueto various health conditions.
- Individuals with Muir-Torre syndrome, whichis a genetic condition.

It is important to note that having a risk factordoes not mean that one will get the condition. Arisk factor increases ones chances of getting acondition compared to an individual without therisk factors. Some risk factors are more importantthan others.
Also, not having a risk factor does not mean thatan individual will not get the condition. It isalways important to discuss the effect of riskfactors with your healthcare provider.

Etiology :
- A majority of cases of Sebaceous Carcinomaof Skin occur in a sporadic manner, withoutany genetic defect or abnormality.- Though, some cases occur due to geneticdefects, caused by mutations in the DNAmismatched repair gene.

Signs and Symptoms of Sebaceous Carcinomaof Skin
Signs and symptoms of Sebaceous Carcinomaof Skin include :
- They can occur as a single tumor or multipletumors, at various parts of the skin.
- Sebaceous Carcinomas usually occur as apainless mass that may ulcerate, as theybecome larger.
- These tumors are generally slow-growingtumors; but, sometimes they may growrapidly.
- The tumors may not be just confined to theskin; occasionally, these can occur in thebreasts, lungs, and in the salivary glands.
- Meibomian Gland Carcinomas occur on theeyelids and this may cause eye irritation,blurred vision, and discomfort.

Diagnosis :
Sebaceous Carcinoma of Skin may be diagnosedusing the following tools:
- Physical exam and evaluation of medicalhistory
- Skin biopsy and the biopsy of any metastaticmass - the specimen is examined under amicroscope by a pathologist, to arrive at adefinitive diagnosis.
Many clinical conditions may have similar signsand symptoms. Your healthcare provider mayperform additional tests to rule out other clinicalconditions to arrive at a definitive diagnosis.

Complications of Sebaceous Carcinoma ofSkin :
The most frequent and main complications withSebaceous Carcinoma of Skin include:
- Recurrence, if incompletely removed
- Cosmetic problems, due to tumor on theeyelids
- Damage of vital nerves, blood vessels, andsurrounding structures, during surgery.
- Metastasis to various organs, which may evenresult in death.

Treatment :
The treatment of Sebaceous Carcinoma of Skinmay include the following:
- A complete surgical excision of the tumor isthe treatment of choice.
- In metastatic Sebaceous Carcinomas, acombination of surgery, chemotherapy, andradiation, may be employed.
- Post-operative care is important: A minimumactivity level is to be ensured until the surgicalwound heals.
- Follow-up care with regular screening andcheck-ups are important.

Prevention :
- Currently, there are no definitive ways toprevent Sebaceous Carcinomas of Skin.
- However, limiting or reducing sun-exposuremay be beneficial.
- By undertaking early and suitable treatment,if individuals have weak immune systems.
- Regular medical screening at periodicintervals with blood tests, scans, and physicalexaminations, are mandatory for those whohave already endured the tumor, due to itsmetastasizing potential and possibility ofrecurrence. Often several years of activevigilance is necessary.

Prognosis :
The prognosis of Sebaceous Carcinoma of Skindepends on the tumor stage. Higher-stagedSebaceous Carcinomas, especially those withdistant metastasis, have poorer prognosis.
- Those tumors that have higher cellproliferation rates, as determined bypathology, after microscopic exam of thetumor, also have poorer prognosis.
- The prognosis is generally better with earlydetection and treatment of the condition.

Additional and Relevant Useful Informationfor Sebaceous Carcinoma of Skin:
Individuals with Sebaceous Carcinoma of Skinshould be encouraged to be tested for Muir-Torre Syndrome.

References
  1. Piazza A, Gu X, Kim RH. Sebaceous carcinoma of the Rt.Arm. Journal of the Louisiana State Medical Society.2012;164(2):81-82 .

  2. Poonam KP, Rajalakshmi T, Julian AC, Suraj M, PritilataR. Extraocular sebaceous carcinoma:a series of three cases with varied presentation. Dermatology Practical &Conceptual. 2012;2(1):39-44. doi: 10.5826/ dpc.0201a07.

  3. David OL, Fred BF, Hernando V, Bernard KK, Maria RP,Jose AC. Inguinal ulcerated sebaceous carcinoma: anunusual presentation. Anais Brasileiros de Dermatologica.2013;88(6):48-51.

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