Characteristics of Sebaceous Carcinoma and Early Outcomes of Treatment Using Mohs Micrographic Surgery Versus Wide Local Excision: An Update of the Mayo Clinic Experience Over the Past 2 Decades JENNIFER L. HOU, BA,* JILL M. KILLIAN, BS,† CHRISTIAN L. BAUM, MD,‡ CLARK C. OTLEY, MD,‡ RANDALL K. ROENIGK, MD,‡ CHRISTOPHER J. ARPEY, MD,‡ AMY L. WEAVER, MS,† AND JERRY D. BREWER, MD‡

BACKGROUND OBJECTIVE

Sebaceous carcinoma (SC) is a rare cutaneous neoplasm.

To characterize SC and treatment approaches and outcomes.

METHODS AND MATERIALS We retrospectively reviewed records of patients with SC from 1992 through 2012. Recurrence-free survival was estimated and compared between groups. RESULTS We identified 52 patients with SC (39, 75.0% male). Mean age  standard deviation at diagnosis was 72.7  10.8. Forty-nine patients (94.2%) were white. Twenty-one (of 29 with known status) had a diagnosis of Muir-Torre syndrome. Six had multiple primary SCs (total of 73 SCs in 52 patients). The most common locations for SC were the back (20.5%), cheek (13.7%), nose (11.0%), and eye (9.6%). Treatment was recorded for 70 SCs; 35 (50.0%) were treated using Mohs micrographic surgery (MMS) and 26 (37.1%) using wide local excision (WLE). Of the 45 patients (66 SCs) with clinical follow-up, three (6.7% of patients; 4.8% of SCs) had documented recurrence. CONCLUSION MMS and WLE are effective treatments for SC. Further research is warranted to determine whether one treatment is more efficacious than the other. The authors have indicated no significant interest with commercial supporters.

S

ebaceous carcinoma (SC) is a rare cutaneous tumor that can behave aggressively.1,2 More than 70% of SCs are located in the head and neck region.1,2 Many studies of SC have concentrated on the periocular area because it previously was believed to present most frequently on the eyelids, but one study suggested that SC may commonly occur outside of the eyelid region.3 Its resemblance to basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and benign inflammatory conditions such as chalazia and blepharoconjunctivitis can complicate diagnosis of SC, and diagnostic delays can result in poor outcomes.4,5 It is important to

distinguish SC from SCC and BCC because SC has higher rates of distant metastases and mortality.3 Patients with SC may have Muir-Torre syndrome (MTS), which warrants screening for internal malignancies and follow-up examinations.6 Studies indicate that older age,1,7–9 female sex,2,10–13 and Asian ethnicity2,14–16 are risk factors for SC. Surgical resection with wide local excision (WLE) has been the standard therapy.5 Studies have since shown lower recurrence rates10,17 and maximal tissue conservation17 with Mohs micrographic surgery (MMS). In this study, we sought to better characterize this relatively unstudied and rare cutaneous

*College of Medicine, Mayo Medical School, Rochester, Minnesota; †Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota; ‡Department of Dermatology, Mayo Clinic, Rochester, Minnesota © 2014 by the American Society for Dermatologic Surgery, Inc.  Published by Wiley Periodicals, Inc.  ISSN: 1076-0512  Dermatol Surg 2014;40:241–246  DOI: 10.1111/dsu.12433 241

SEBACEOUS CARCINOMA CHARACTERISTICS AND TREATMENT

tumor and to compare the efficacy of WLE and MMS treatments.

Methods After approval for this study was obtained from the Mayo Clinic Institutional Review Board, patients with the diagnosis of SC seen from January 1, 1992, through April 20, 2012, were identified by querying the institution’s master diagnosis index. We retrospectively reviewed the medical records and abstracted patient age, sex, date of diagnosis of SC, location of tumor, family and personal history of other skin cancers, history of colon cancer, MTS status, treatment, date of recurrence, type of treatment (WLE or MMS), date of last relevant clinical follow-up, and last follow-up by any means or death.

Results We identified 52 patients with a total of 73 SCs. Tables 1 and 2 summarize patient and disease characteristics. Of the 45 patients with relevant clinical follow-up (66 SCs), six had more than one primary SC (1 each had 14, 4, and 3 primary SCs, respectively, and 3 each had 2 primary SCs). Three patients (2 male, 1 female) had documented recurrence, with time to recurrence of 0.3, 2.2, and 6.0 years. Of the remaining patients (62 SCs) with clinical follow-up and no documented recurrence, the median duration of relevant clinical follow-up was 1.0 year (interquartile range 0.3–2.1 years). One patient (2.2% of patients with relevant followup) had an SC on the chest that metastasized to an axillary lymph node approximately 4 months after diagnosis. No cause-specific deaths were confirmed. Table 3 summarizes patient characteristics of the three patients with documented recurrence. All had a history of BCC and SCC, and two were positive for MTS. One had initial treatment with biopsy only, one was treated with MMS, and one underwent WLE.

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TABLE 1. Patient Characteristics (N = 52) Characteristic

Value

Male, n (%) 39 (75.0) Race, n (%) White 49 (94.2) Black 2 (3.8) Native American 1 (1.9) Age at diagnosis, mean  standard deviation Overall 72.7  10.8 Men 75.0  10.7 Women 73.4  11.3 Family history of skin cancer 13 (28.3) (n = 46), n (%) Personal history of skin cancer, n (%) None 14 (26.9) BCC only 8 (15.4) SCC only 7 (13.5) BCC and SCC only 19 (36.5) Other 4 (7.7) Personal history of colon cancer, 14 (26.9) n (%) Muir-Torre syndrome (n = 29), n (%) 21 (72.4) Fitzpatrick skin type (n = 34), n (%) 1 4 (11.8) 1–2 3 (8.8) 2 14 (41.2) 2–3 7 (20.6) 3 2 (5.9) 3–4 1 (2.9) 4 1 (2.9) 5 1 (2.9) 6 1 (2.9) Data for some patients were missing or unknown; denominators used to calculate percentages are provided when the total numbers of patients was

Characteristics of sebaceous carcinoma and early outcomes of treatment using Mohs micrographic surgery versus wide local excision: an update of the Mayo Clinic experience over the past 2 decades.

Sebaceous carcinoma (SC) is a rare cutaneous neoplasm...
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