In this retrospective case review study, authors report their outcomes in management of recurrent sebaceous gland carcinoma (SGC) and propose a graded protocol to manage these entities. All consecutive cases of SGC from January 2004 to December 2017 at the Royal Hallamshire Hospital, Sheffield were assessed. They included cases of SGC with confirmed recurrence during the study period and excluded cases who had initial or subsequent management at different centres and those left to follow-up. Of the 62 cases with eyelid SGC diagnosed between January 2004-December 2017, 10 were included in the study based on the inclusion criteria. The most common presenting symptom was appearance of an eyelid mass (n=5) or irritation (n=5). Associated sign of eyelid margin thickening was noted in five cases. The mean time interval between initial excision and recurrence was 37 months (range 14-84 months). Metastatic disease was diagnosed in two patients. Patients received full thickness biopsy +/-conjunctival mapping biopsies and adjuvant cryotherapy +/- intralesional or topical Interferon alpha-2a. Four patients underwent orbital exenteration due to inadequate disease control, invasive SGC with extensive non-resectable pagetoid spread, pagetoid in situ SGC causing painful blind eye due to limbal stem cell failure. Two of 10 patients developed metastases. Two patients passed away during study period one with evidence of metastasis and another not related to the tumour. Based on their results, the authors propose close follow-up for first two years and total follow-up of up to 10 years to ensure no local recurrence after initial diagnosis with low threshold for rebiopsy and adjuvant therapy if required. They also propose globe preserving local treatment options and exenteration surgery to be considered in severe cases of in situ or invasive disease.
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