Shields Jerry A, Saktanasate Jarin, Lally Sara E, Carrasco Jacqueline R, Shields Carol L
From the *Ocular Oncology Service, and †Oculoplastics Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA.
Asia Pac J Ophthalmol (Phila). 2015 Jul-Aug;4(4):221-7. doi: 10.1097/APO.0000000000000105.
Sebaceous carcinoma is a malignancy arising in the periocular region that can lead to blindness and tumor-related metastases. This study is a review of published literature and personal experience. This malignancy can arise from the sebaceous units in the tarsus (meibomian glands), in association with the cilia (Zeis glands), in the brow, and in the caruncle. There is a tendency for diffuse intraepithelial growth (pagetoid spread) that can be clinically invisible. Detection before lymph node metastasis is critical. This malignancy often masquerades as chronic unilateral conjunctivitis or blepharitis, typically in older patients. Management includes a 2-step approach with step 1 focused on eyelid and conjunctival map biopsies to determine the full extent of solid deep tumor and pagetoid spread. After complete review of all biopsies, step 2 is performed using local resection for all deep tumor, cryotherapy to pagetoid disease, and reconstruction. In most cases, the posterior lamella of eyelid is sacrificed with tumor removal, whereas the anterior lamella of the eyelid can be saved. After removal and cryotherapy, immediate reconstruction, using clean instruments, with buccal membrane graft for the posterior lamella and skin flap for the anterior lamella, is developed. For persistent or recurrent pagetoid disease, cryotherapy, topical mitomycin C, or plaque radiotherapy is provided. Exenteration is sometimes necessary. Sebaceous carcinoma, if detected early, can be managed with carefully planned map biopsy to determine tumor extent, followed by local resection, cryotherapy, and eyelid reconstruction. Orbital exenteration is occasionally necessary.
皮脂腺癌是一种发生于眼周区域的恶性肿瘤，可导致失明及肿瘤相关转移。本研究是对已发表文献及个人经验的综述。这种恶性肿瘤可起源于睑板中的皮脂腺单位（睑板腺）、与睫毛相关的腺体（蔡司腺）、眉部及泪阜。存在弥漫性上皮内生长（派杰样扩散）的倾向，临床上可能难以察觉。在发生淋巴结转移之前进行检测至关重要。这种恶性肿瘤常伪装成慢性单侧结膜炎或睑缘炎，多见于老年患者。治疗包括两步法，第一步重点是进行眼睑和结膜的地图活检，以确定实性深部肿瘤及派杰样扩散的全部范围。在全面评估所有活检结果后，第二步是对所有深部肿瘤进行局部切除、对派杰样病变进行冷冻治疗并进行重建。在大多数情况下，切除肿瘤时会牺牲眼睑的后层，而眼睑的前层可以保留。切除和冷冻治疗后，使用清洁器械，立即进行重建，后层用颊黏膜移植，前层用皮瓣。对于持续性或复发性派杰样病变，可采用冷冻治疗、局部应用丝裂霉素C或敷贴放疗。有时需要进行眼球摘除术。皮脂腺癌如果早期发现，可通过精心规划的地图活检确定肿瘤范围，随后进行局部切除、冷冻治疗和眼睑重建。偶尔需要进行眼眶内容剜除术。
