Sebaceous carcinoma in immunosuppressed patients: a narrative review

Sebaceous carcinoma is a rare cutaneous malignancy of sebaceous glands, but it is up to 25-fold more common in immunosuppressed individuals. In this narrative review, we examine the current literature on the pathogenesis, incidence, risk factors, prognosis, treatment, and surveillance of sebaceous carcinoma in immunosuppression and highlight practical considerations for providers who care for these patients. Increased incidence may be related to decreased immune surveillance, susceptibility to an unknown viral trigger, microsatellite instability, immunosuppressive medications, and unmasking of occult Muir-Torre Syndrome. Risk factors include type of immunosuppression, specific immunosuppressive medications and duration of treatment, and extensive solar damage. Prognosis may be similar to the general population, though data are conflicting. Treatment for primary sebaceous carcinoma is generally surgical, though in patients with high-risk tumors, adjuvant therapy may be advisable. Immunosuppressed patients should have regular screening skin exams, and those with a history of sebaceous carcinoma should have more frequent checks. Providers may consider genetic testing for patients with other features suggestive of occult Muir-Torre Syndrome. If found to have germline Muir-Torre Syndrome mutations, these patients require more rigorous surveillance.