Sebaceous gland carcinoma involving the medial canthus: 14-year experience at a tertiary eye centre in the United Kingdom

PURPOSE: To describe the presentation, management and outcomes of periocular sebaceous gland carcinoma (SGC) involving the medial canthus at a tertiary ophthalmic unit. METHODS: Retrospective consecutive case series of adults with histopathologically confirmed periocular SGC involving the medial canthus managed at Moorfields Eye Hospital between October 2010 and October 2024. Demographic, clinical, histopathological, treatment and outcome data were reviewed. RESULTS: Fifteen of 99 (15%) patients with periocular SGC had medial canthal involvement. Mean age was 74 years and 9/15 (60%) were female. Mean symptom duration before presentation was 18.5 months. Eight patients (53%) were referred after biopsy elsewhere, including 4 initially diagnosed with squamous cell carcinoma. Poor differentiation was present in 10/15 (67%) and pagetoid spread in 9/15 (60%). Lacrimal outflow involvement was identified on histopathological analysis of exenteration specimens in 2/15 (13%) despite no clinical or radiological evidence. Primary surgery comprised wide local excision in 7/15 (47 %), Mohs micrographic surgery in 2/15 (13%) and orbital exenteration in 5/15 (33%); one patient declined treatment. Six of 14 (43%) treated cases required additional surgery to achieve clearance, including 5/9 (56%) after local excision and 1/5 (20%) after exenteration. Over a median follow-up of 42 months (range 5-149 months), one patient developed local recurrence requiring exenteration; there were no metastases or disease-related deaths. CONCLUSIONS: Medial canthal SGC presents diagnostic and surgical challenges, including histopathological misclassification, difficulty achieving clear margins and clinically occult lacrimal outflow involvement. Eight of 14 (57%) treated patients underwent globe-preserving surgery and remained free of recurrence, metastases, or disease-related death over follow-up. Careful histopathological assessment and multidisciplinary specialist management are important, and globe-preserving surgery may be appropriate in selected cases.