Four-eyelid sebaceous cell carcinoma following irradiation

Background: Sebaceous cell carcinoma is a distinctive tumor of the eyelid a ssociated with a high rate of metastasis and mortality. Involvement of both upper and lower lids has been described; however, involvement of all 4 eye lids is extremely rare. Objective: To describe the evaluation and diagnosis of the clinicopathologi c features in a 74-year-old patient with 4-eyelid sebaceous carcinoma and a history of whole face irradiation for eczema. Methods: Bilateral eyelid, conjunctiva, map, and fine needle biopsy of enla rged, submandibular lymph node specimens were stained with hematoxylin-eosi n and oil-red-O for light microscopy and fresh-frozen sections were evaluat ed by electron microscopy. Results: The biopsy specimens from the eyelids and conjunctiva showed sebac eous carcinoma cells in the meibomian glands and scattered within the conju nctival epithelium. The cells were moderately well differentiated. Similar cells stained with oil-red-O were found in the submandibular lymph nodes. Conclusions: The appearance of bilateral sebaceous carcinoma supports the c oncept of simultaneous occurrence of multiple primaries in specific patient s, especially after radiation therapy. Patients with a history of facial ir radiation and atypical eyelid lesions should be evaluated for malignant tum ors such as sebaceous carcinoma.