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This was a review of 29 patients who had undergone orbital exenteration for sebaceous cell carcinoma. Prompted by the increasing use of topical treatments for intraepithelial disease, the authors were keen to discover the frequency of spread of tumour cells beyond the ocular surface, that might be inadequately treated by drops alone. Of the 29 exenterations, 17 had no tumour nodule or mass, only intraepithelial disease with or without microinvasion. Five of these 17 had evidence of spread beyond the conjunctiva and cornea. One patient had lacrimal gland invasion, two had sac disease and two others had both sac and gland involvement. Of the 12 patients who had a discernible nodule accompanied by intraepithelial Pagetoid spread, three had lacrimal gland disease. The mean survival to tumour-related death was significantly shorter in those who had sac or gland involvement. Overall, 28% of patients had disease involving the lacrimal gland and / or sac. The authors admit that as their cohort dates back to 1997, prior to topical therapies becoming accepted treatment, there may be some bias towards a subgroup of patients with more advanced in-situ disease. However, the high rate of spread beyond the ocular surface does suggest that topical therapy may have significant limitations especially for hidden lacrimal gland disease.

Could extension into the lacrimal gland and sac thwart topical chemotherapy for intraepithelial sebaceous carcinoma?
Gupta T, Vahdani K, Rose GE, et al.
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James Hsuan

Aintree University Hospital, Liverpool, UK.

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