A 65-year-old man has a slowly progressive painless loss of eyelashes and recurrent 'chalazion-like' swellings in the upper eyelid that recur at the same site after drainage. On eversion of the upper lid, the conjunctiva shows a velvety, hyperemic, diffusely thickened area. What is the most important diagnosis to exclude and what investigation is indicated?
- A Meibomian gland dysfunction; meibography
- B Mucoepidermoid carcinoma; fine needle aspiration
- C Sebaceous gland carcinoma (SGC) of the lid; full-thickness lid biopsy with fat staining (oil red O) ✓
- D Basal cell carcinoma with perineural invasion; MRI orbit
Explanation
Sebaceous gland carcinoma (SGC) of the eyelid is a malignant tumor of the meibomian glands or glands of Zeis that classically masquerades as a recurrent chalazion, blepharitis, or conjunctivitis—earning the name 'the great masquerader.' Pagetoid spread onto the conjunctival surface explains the diffuse thickened hyperemic conjunctiva (intraepithelial spread). Loss of lashes (madarosis) occurs as the tumor destroys follicles. Diagnosis requires full-thickness eyelid biopsy with lipid staining (oil red O on frozen section) because the lipid content is dissolved in paraffin. SGC has a significant risk of orbital and systemic metastasis.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.