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Sebaceoma or Sebaceous Carcinoma?


Dr. Mona Abdel-Halim

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[b][i][size=4]Mona R.E. Abdel Halim[/size][/i][/b]
[center][b][i][size=4]MD Dermatology, Diploma of Dermatopathology (ICDP-UEMS)[/size][/i][/b][/center]

 


[size=4] I have followed with great attention a spot diagnosis case in this excellent website that was posted by Dr Mark Hurt in December 2015. A split of opinions has happened in this case between a sebaceoma and a sebaceous carcinoma, with Dr Mark giving the final diagnosis as a moderately differentiated sebaceous carcinoma. [/size]
[size=4] I actually respected both opinions and could understand the points behind each of them. The lesion was very well circumscribed with scattered mitoses but there was subtle nuclear pleomorphism. However, this frightened me a bit!! A lesion would be considered benign by some pathologists and malignant by others?? Would there be a risk of metastasis if the patient's final diagnosis was sebaceoma while he actually has a sebaceous carcinoma? Was the very subtle nuclear pleomorphism sufficient to diagnose a carcinoma in spite of the very circumscribed and non infiltrative nature of the lesion? [/size]
[size=4] I understand that dermatopathology has many gray areas where a clear cut definition of benign versus malignant can be very difficult but what are we supposed to do then? Would proliferation markers help in such cases? It might be better to be on the cautious side and consider those gray lesions as malignant and ensure a complete excision with a safety margin but couldn't this be a cause of patient's morbidity? [/size]

 

[size=4]Any insights?? [/size]

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