Basal and squamous cell carcinomas. Basal cell carcinomas often feature translucent lesions on areas of the skin that are exposed to sunlight. These lesions often have slightly rolled border edges or overlying branching telangiectasia and may be nodular.3 Squamous cell carcinomas often feature scaled, reddened patches that may become tender and ulcerate.4
Hordeolums and chalazions. A hordeolum (or stye) is a painful, acute, localized swelling of the eyelid.5 These often develop externally at the lid margin from infection of the follicle. A chalazion is characterized by a persistent, nontender mass that results from small, noninfectious obstruction of the Meibomian glands with secondary granulomatous inflammation.5
Dermoscopy can (and did) help with the Dx
Dermoscopy can help confirm whether a lesion has a sebaceous origin because it would show yellow globules with “crown vessel” telangiectasias that classically do not cross midline.6 Unfortunately, the findings of yellow globules and dermal vessels do not adequately differentiate benign from malignant lesions.6 Carcinomas can manifest in an undifferentiated way early in their course.
Sebaceous carcinomas can be associated with the autosomal dominant Muir-Torre syndrome, a subset of the Lynch syndrome.7,8 Colorectal and genitourinary carcinomas are the most common internal malignancies seen in patients with Muir-Torre syndrome.9
Patients benefit from Mohs surgery
Treatment outcomes for sebaceous carcinoma appear to be improved by Mohs surgery. In a recent review of 1265 patients with early-stage sebaceous carcinomas, Su et al found that 234 patients who were treated with Mohs surgery had improved overall survival, compared with 1031 who were treated with surgical excision.10
Continue to: Our patient