Efficacy of Topical Chemotherapy in Ocular Adnexal Sebaceous Carcinoma

This study aimed to report clinical outcomes of topical chemotherapy for ocular adnexal sebaceous carcinoma (OaSC) with intraepithelial spread. A retrospective chart review of patients with OaSC treated at the Bascom Palmer Eye Institute between 2000 and 2023 was conducted. Patient inclusion criteria included: (1) biopsy-proven diagnosis of OaSC, (2) intraepithelial pagetoid involvement confirmed by conjunctival map biopsy, (3) implementation of topical chemotherapy for tumor control, and (4) repeat conjunctival map biopsy following cessation of topical chemotherapy. We reviewed 120 patients with OaSC and 10 patients met the inclusion criteria (n = 10). Topical chemotherapy agents were utilized via monotherapy or in combination and included mitomycin C (MMC) 0.02% or 0.04% (8 cases), 5-fluorouracil 1% (3 cases), and interferon alpha-2a 1 million units/ml (2 cases). Inadequate control of intraepithelial disease was observed in 8 (8/10, 80%) of cases. Resolution of pagetoid disease was achieved in 2 patients (2/10, 20%) with MMC monotherapy. Seven patients (7/10, 70%) experienced adverse effects from topical chemotherapy, with MMC accounting for 6 cases and 5-fluorouracil accounting for 1 case. Topical chemotherapy was ineffective in controlling the majority of OaSC patients with pagetoid involvement. Both patients who achieved local conjunctival tumor control were treated with MMC for at least 3 total weeks of therapy, although residual disease within the eyelid was still identifiable on pathology following surgical resection. Topical MMC may be used in the neoadjuvant setting for OaSC with pagetoid spread; however, additional studies are needed to determine the optimal dosing and treatment duration to minimize adverse effects and reduce ocular surface comorbidity.