Treatment Delay and Risk of Orbital Exenteration in Periocular Sebaceous Carcinoma

Introduction: This single-institution study characterizes outcomes in periocular sebaceous carcinoma and evaluates whether treatment delay is associated with orbital exenteration. Methods: Retrospective case series of all patients diagnosed with primary periocular sebaceous carcinoma between 1/1/2000 and 12/31/2022 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. Results: 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. Conclusion: 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.