Treatment Delay and Risk of Orbital Exenteration in Periocular Sebaceous Carcinoma

This single-institution study characterizes outcomes in periocular sebaceous carcinoma and evaluates whether treatment delay is associated with orbital exenteration.

Retrospective case series of all patients diagnosed with primary periocular sebaceous carcinoma between January 1, 2000, and December 31, 2022, at a single academic institution. Clinical, histopathologic, treatment, and outcome data were analyzed. Association between time to treatment and orbital exenteration was assessed using logistic regression.

The study included 25 patients (median age 76.6 years). Prior misdiagnosis occurred in 21 (84%), most commonly as chalazia (n = 7) or blepharitis (n = 6). Most tumors were AJCC T1, with predominantly poor or moderate differentiation. Mean time from presentation-to-treatment was 5.67 months (range 0.26-28.52 months), with a subset experiencing prolonged delays. Most patients underwent wide local excision (52%) or Mohs surgery (32%), with 4 (16%) requiring exenteration. Each 3-month increase in time to treatment was associated with 16% greater odds of orbital exenteration (OR: 1.16, 95% CI: 1.01-1.38; p = 0.042). Demographic and socioeconomic variables were not associated with differences in delays or outcomes. Median follow-up was 43 months, during which visual acuity remained stable in non-exenterated patients (median logMAR change -0.125). Local tumor recurrence occurred in 4 (16%) at a median of 26.46 months. Overall survival was 54.2% at 10 years, with no deaths attributed to sebaceous carcinoma.

Treatment delay was associated with increased odds of orbital exenteration and not with measured socioeconomic factors. These findings suggest a potential relationship between time-to-treatment and extent of surgical management, with possible implications for vision preservation and quality of life.