This is a study investigating the risk of developing a second primary malignancy in patients previously diagnosed with eyelid sebaceous cell carcinoma. The records of 559 patients who were diagnosed with sebaceous cell carcinoma between 2000 and 2016 were reviewed, and 16% were found to develop second primaries, which represents a 61% excess risk compared to a matched reference population. Only a third of these had received radiotherapy. Second primary locations with a significantly increased risk of malignancy included salivary gland, pancreas, respiratory tract, and skin (non-melanoma). Women were at greater risk than men, and non-Hispanic Caucasians more than other races. Women also had an increased risk of breast cancer and chronic lymphocytic leukaemia. Interestingly, they did not find an increased risk of colonic tumours as in the Muir-Torre syndrome, reinforcing the opinion that Muir-Torre syndrome is more closely related to sebaceous adenoma than sebaceous carcinoma. The authors were unable to explain the increased risk, but speculated that genetic and possibly lifestyle factors were the best targets for further investigation.