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Intraoperative 5-Aminolevulinic Acid Fluorescence in Periocular Sebaceous Carcinoma: A Proof-of-Concept Case Report
Elana Meer1,2, Melike Pekmezci1,3, Nickisa Hodgson1,2
1Department of Ophthalmology.
Ophthalmic Plastic and Reconstructive Surgery
|May 27, 2026
Summary
5-aminolevulinic acid (5-ALA) fluorescence effectively identified hidden periocular sebaceous carcinoma during surgery. This technique shows promise for improving tumor margin assessment in eye and eyelid cancer treatment.
Area of Science:
- Oncology
- Ophthalmology
- Surgical Innovation
Background:
- Sebaceous carcinoma presents diagnostic challenges due to subtle spread.
- Intraoperative visualization of periocular tumors is difficult.
- 5-aminolevulinic acid (5-ALA) fluorescence is established in other cancers.
Purpose of the Study:
- To evaluate 5-ALA fluorescence for delineating periocular sebaceous carcinoma.
- To correlate intraoperative fluorescence with histopathology.
- To assess 5-ALA as an adjunct for tumor mapping in ocular oncology.
Main Methods:
- A single patient with periocular sebaceous carcinoma received oral 5-ALA.
- Intraoperative fluorescence was assessed under blue light.
- Fluorescent and non-fluorescent tissues were analyzed histopathologically.
Main Results:
- 5-ALA induced distinct fluorescence in cancerous tissues of the eyelid and conjunctiva.
- Histopathology confirmed sebaceous carcinoma in all fluorescent areas.
- Non-fluorescent areas were tumor-free, and sentinel nodes were negative.
Conclusions:
- 5-ALA fluorescence accurately identified occult periocular sebaceous carcinoma in vivo.
- The findings support 5-ALA's potential role in intraoperative tumor mapping.
- This technique may aid in margin assessment for globe-sparing surgery.