Sebaceous carcinoma masquerading as ocular mucous membrane pemphigoid

Area of Science:

• Ophthalmology
• Dermatology
• Oncology

Background:

• Sebaceous carcinoma is often misdiagnosed as benign conditions, causing treatment delays.
• Ocular mucous membrane pemphigoid (MMP) is a cicatrizing conjunctivitis that can present similarly to other inflammatory conditions.

Observation:

• Two patients with chronic cicatrizing conjunctivitis, initially diagnosed with ocular MMP, were later found to have sebaceous carcinoma.
• Both patients presented with unilateral conjunctivitis unresponsive to therapy, developing fornix foreshortening and symblepharon.

Findings:

• Case 1 was diagnosed with ocular MMP clinically; Case 2 had biopsy-negative disease.
• Months to years later, both developed lid lesions confirmed as sebaceous carcinoma, requiring exenteration.

Implications:

• Clinicians must consider sebaceous carcinoma in chronic conjunctivitis, particularly when mimicking ocular MMP, even with biopsy-negative findings.
• A high index of suspicion and repeat biopsies are crucial for early sebaceous carcinoma detection in chronic inflammatory eye conditions.
• The increasing acceptance of biopsy-negative ocular MMP diagnoses necessitates vigilance for alternative diagnoses like sebaceous carcinoma.