Sebaceous gland carcinoma

Sebaceous gland carcinoma is a very rare type of skin cancer. It starts in the sebaceous glands. These are the glands that produce our natural skin oils.

There are sebaceous glands all over our bodies. So this type of cancer can be diagnosed anywhere in the body. But the most common site is the upper eyelid.

Sebaceous gland carcinoma is very rare. Just over 700 people were diagnosed with it in England between 1999 and 2008.

Risks and causes of sebaceous gland carcinoma

There are some factors that increase your risk of developing sebaceous gland carcinoma. But having a risk factor doesn’t mean that you will develop this cancer.

Some factors that can increase your risk include:

• non cancerous lumps (benign adenomas) of the sebaceous glands
• exposure to radiation – for example, previous treatment with radiotherapy
• a genetic condition called Muir Torré syndrome
• having a weakened immune system following organ transplant

Muir Torré syndrome can mean that you have another primary cancer elsewhere in your body. So people diagnosed with sebaceous gland cancer are often checked over for signs of cancer elsewhere. This can be frightening, but it's usually just a precaution.

This type of skin cancer is more common in women than men. It's more common in elderly people.

Symptoms

Sebaceous gland carcinoma usually appears as a firm, painless lump. It can be a yellowish colour.

The most common site is the upper eyelid. 75 out of 100 (75%) of these cancers are diagnosed around the eye. You can also have sebaceous gland carcinoma elsewhere on your body including:

• the head or neck
• the central part of your body (trunk)
• the genital area.

Unfortunately, it can spread to other parts of the body such as the lymph nodes, lungs, liver, or bones.

Tests

The main test is to take a sample of tissue (biopsy) of the area. Your doctor takes a sample of skin and sends it to the laboratory to be looked at under the microscope. You usually have a biopsy under local anaesthetic, which numbs the area.

You might need to have further tests to see if the cancer has spread to other parts of the body. You might have:

• a chest x-ray
• an ultrasound scan
• lymph node biopsy
• a CT scan or PET-CT scan
• an MRI scan

Staging

The stage of a cancer tells you how big it is and whether it has spread. It helps your doctor decide which treatment you need.

There are different systems for staging sebaceous skin cancers, depending on where they start.

Sebaceous gland carcinoma that starts in the eyelid are staged as eyelid cancers.

Sebaceous gland carcinoma that starts elsewhere on your body, are staged as skin cancers.

Treatment for sebaceous gland carcinoma

You should have treatment at a specialist skin cancer centre because this is a rare type of skin cancer. A team of doctors discuss the best treatment and care for you. They are called a multidisciplinary team (MDT). The MDT includes a skin specialist (dermatologist), a plastic surgeon and a cancer radiotherapy specialist (clinical oncologist).

The treatment you have depends on:

• where the cancer started and its size
• whether it has spread
• your general health

Your doctor will discuss your treatment, its benefits and the possible side effects. The main treatments for sebaceous gland carcinoma are:

• surgery
• radiotherapy

Your doctor might offer you further treatment after surgery. This is called adjuvant treatment and includes chemotherapy cream or using extreme cold to destroy cancer cells (cryotherapy). It isn't very common to have adjuvant treatment. 

Surgery

Surgery is the main treatment. Your surgeon aims to remove all the cancer cells and some healthy tissue around it (a healthy margin).

The surgeon might not know the extent of your cancer before surgery. So they might need to remove more tissue than expected. Your surgeon will talk about this with you before your operation. 

There are different types of surgery. You might have:

• mohs micrographic surgery
• a wide local excision (WLE)
• surgery to remove lymph nodes

Your surgeon might also remove the lymph nodes around the cancer. This is where the cancer cells are most likely to travel first. The operation is called a lymph node dissection.

Radiotherapy

Radiotherapy means the use of radiation, usually x-rays, to kill cancer cells. You might have it:

• after surgery to kill any cancer cells that might have been left behind - this is called adjuvant treatment
• as your only treatment if you can’t have surgery for any reason

You usually have it once a day, Monday to Friday, for 5 weeks. 

Surgery to your eye

It can sometimes be difficult to completely remove cancers that start close to the eye.

Very rarely, you might need a larger operation to remove your eye and surrounding tissue. This is to make sure the surgeon has removed all of the cancer. 

Treatment for cancer that has spread

Treatment for cancer that has spread to other parts of the body won’t get rid of the cancer. But it can control your symptoms and help you feel better.

You might have chemotherapy. Your doctor might offer you treatment as part of a clinical trial.

Follow up

You have regular appointments with your doctor or nurse after treatment. You might have appointments at least every 6 months for the first 3 years. And then every year after that.

During the follow up appointments, your doctor checks how you are. You can raise any concerns or problems you have with them.

You might have scans such as a CT or ultrasound scan. Your doctor will tell you more about what tests you need, and how often.

Coping

Coping with a diagnosis of cancer can be difficult. You might feel sad and worry about what will happen. Being well informed about your cancer and its treatment can make it easier to make decisions and cope with what happens afterwards.

Talking to other people

Talking to people who have the same condition can help.

Our discussion forum Cancer Chat is a place for anyone affected by cancer. You can share experiences, stories and information with other people who know what you are going through.

The Rare Cancer Alliance offer support and information to people affected by rare cancers.