Sebaceous carcinoma presenting as chronic chalazion

We present a case of sebaceous carcinoma presenting as treatment-resistant chalazion. Diagnosis was made by excisional biopsy after failed treatment with warm compresses, eyelid hygiene and erythromycin ointment. Conjunctival map biopsies excluded local spread. MRI of the orbits and whole-body positron emission tomography demonstrated no metastatic disease. Definitive treatment was accomplished by wide local excision with no recurrence at 1-year follow-up. Sebaceous carcinoma often masquerades as benign diagnoses, such as blepharitis and chalazion, yet it is an aggressive cancer with high rates of morbidity and mortality. Thus, a high level of suspicion is required to avoid vision loss and death by metastatic disease. There are currently no targeted therapies for advanced disease, highlighting the importance of prompt diagnosis. Furthermore, recognition of the association of sebaceous carcinoma with Muir-Torre Syndrome is important to guide future cancer screening and management.