Diagnostic discrepancy in periocular sebaceous carcinoma: A 12-year review and perspectives on emerging diagnostic tools
Eduardo Lobo da Rosa de Almeida, Juliana Portela Passos, Carolina R. N. M. Santos, Jacqueline Coblentz, Guilherme Feltrin De Barros, Emily Marcotte, Miguel N. BurnierAbstract
Introduction:
Periocular sebaceous carcinoma (SC) is an uncommon but aggressive malignancy that often mimics benign or other malignant eyelid lesions, leading to delayed or incorrect clinical diagnosis. This study evaluated clinical–pathological concordance in periocular SC and explored the potential role of ancillary diagnostic tools in improving diagnostic accuracy.
Methods:
A retrospective review was conducted of 92 eyelid tumors submitted with a clinical diagnosis or suspicion of SC to the McGill University Health Centre–McGill University Ocular Pathology and Translational Research Laboratory between 2006 and 2018. Histopathological diagnoses were compared with initial clinical impressions to determine concordance rates and identify patterns of misdiagnosis.
Results:
SC was histopathologically confirmed in 28 of 92 (30%) cases. Among confirmed SC cases, 14 (50%) were clinically suspected as SC, while the remainder were misdiagnosed as basal cell carcinoma (BCC) (36%), squamous cell carcinoma (14%), chalazion (14%), or other benign lesions. Of the 64 tumors not confirmed as SC, common clinical impressions included chalazion (42%), BCC (27%), and chronic inflammation (22%). Overall, half of the true SC cases were not clinically recognized.
Conclusion:
Periocular SC demonstrates substantial clinical–pathological discordance, frequently masquerading as benign or alternative malignant lesions. Histopathological confirmation remains essential, even for clinically innocuous presentations. Emerging adjuncts such as Preferentially Expressed Antigen in Melanoma immunostaining and artificial intelligence–assisted digital pathology may enhance diagnostic precision and support earlier, more appropriate management.