Sebaceous Carcinoma Incidence and Survival Among Solid Organ Transplant Recipients in the United States, 1987-2017

Importance

Risk of sebaceous carcinoma (SC), a rare skin cancer associated with Muir-Torre syndrome, is elevated among solid organ transplant recipients (SOTRs). However, population studies evaluating this association and assessing survival for posttransplant cases are lacking, and further understanding of SC epidemiology in this immunosuppressed population could provide etiologic and clinical insights.

Objective

To assess SC incidence and patient survival after solid organ transplantation.

Design, Setting, and Participants

This cohort study, conducted from January 1, 1987, to December 31, 2017, used data from the Transplant Cancer Match Study, which links transplant and cancer registry data for 17 states and 1 metropolitan area in the United States. Altogether, these registries account for approximately 46% of all US transplants. Data on demographic and transplant characteristics as well as induction and initial maintenance immunosuppressive therapies were obtained from the transplant registry. Standardized incidence ratios (SIRs) comparing SC incidence among SOTRs to the general population were calculated. Incidence rate ratios (IRRs) comparing SC risk between SOTR subgroups were calculated using multivariate Poisson regression. Cox regression was used to compare overall survival between SC cases in SOTRs and other individuals.

Main Outcomes and Measures

Sebaceous carcinoma incidence and overall patient survival after transplantation compared with the general population.

Results

A total of 326 282 transplant procedures were performed for 301 075 patients (No. [%] age at transplant, 126 550 [38.8%] aged 0-44 years; 82 394 [25.3%] aged 45-54 years; 82 082 [25.5%] aged 55-64 years; 35 256 [10.8%] aged ≥65 years; 201 354 male patients [61.7%]; 202 557 White patients [62.1%]). A total of 102 SCs were diagnosed in 301 075 SOTRs, corresponding to a 25-fold increased incidence (SIR, 24.8; 95% CI, 20.2-30.1). Incidence was especially elevated among lung recipients (SIR, 47.7; 95% CI, 20.6-94.0) and after a posttransplant diagnosis of cutaneous squamous cell carcinoma (SIR, 104.0; 95% CI, 62.8-163.0). Among SOTRs, factors independently associated with SC risk included male sex (IRR, 2.46; 95% CI, 1.48-4.07; P < .001), race/ethnicity (non-Hispanic Black vs non-Hispanic White, IRR, 0.28; 95% CI, 0.10-0.77; P = .01), older age (IRR, 7.85; 95% CI, 3.85-16.0; ≥65 vs 0-44 years; P < .001 for trend), use of thymoglobulin induction (IRR, 1.82; 95% CI, 1.16-2.86; P = .009), posttransplant cutaneous squamous cell carcinoma (IRR, 4.60; 95% CI, 2.67-7.94; P < .001), and longer time since transplant (IRR, 8.40; 95% CI, 3.94-17.90; ≥10 vs 0-1.9 years; P < .001 for trend). Muir-Torre syndrome-associated cancers were rare among both SOTRs and others with SC (3.3%-4.1%). Among patients with SC, prior transplantation was associated with increased overall mortality (adjusted hazard ratio, 2.09; 95% CI, 1.45-3.01), although few deaths were attributed to SC (4 of 92 SOTRs [4.3%]; 235 of 3585 non-SOTRs [6.6%]).

Conclusions and Relevance

Among SOTRs, results of this large cohort study suggest that SC was associated with measures of immunosuppression, and overall survival was worse than for other patients with SC. Findings also suggest a possible role for UV radiation in carcinogenesis.

Sebaceous adenomas in an MYH associated polyposis patient of Indian (Gujarati) origin

MYH associated polyposis is an autosomal recessive polyposis syndrome with a high risk of large bowel cancer, caused by mutations in the DNA repair gene MYH. Founder mutations have been described in different ethnic groups. Muir Torre Syndrome is the association of internal malignancies with sebaceous gland tumours; Lynch Syndrome/Hereditary Non Polyposis Cancer is the best known cause. There has been a previous report of sebaceous gland tumours in an Italian patient with MYH associated polyposis. We describe a man of Indian (Gujarati) descent who has MYH associated polyposis and multiple sebaceous adenomas of the skin.

Sebaceous Carcinoma of the Eyelid: A Review of 14 Cases

BACKGROUND

Sebaceous carcinoma of the eyelid is a rare tumor. Treatment can be complicated by noncontiguous spread of the tumor.

OBJECTIVE

Review a series of patients with sebaceous carcinoma to illustrate clinical presentations, treatments, and outcomes.

METHODS

We retrospectively reviewed medical records of patients with sebaceous carcinoma treated at Mayo Clinic (Rochester, MN).

RESULTS

Fourteen patients had sufficient follow-up data available for review. Mean follow-up was 57 months (range 18-134 months). Treatment included wide local excision with frozen and permanent section control (9 patients, 64%), Mohs micrographic surgery (2 patients, 14%), external beam radiation (2 patients, 14%), and exenteration and total parotidectomy with cervical lymph node dissection (1 patient, 7%). Two patients (14%) had local recurrence of the tumor after wide local excision, and 1 patient (7%) had tumor recurrence after Mohs micrographic surgery.

CONCLUSION

Treatment should be chosen on the basis of the extent of the tumor and the specific needs of the patient. The mainstay of treatment of tumors without orbital involvement has been wide local excision, with the margins checked in both permanent and frozen sections, in combination with conjunctival map biopsies when warranted. Mohs micrographic surgery is an alternative that may provide tissue conservation and lower recurrence rates. Recurrence rates between treatments are difficult to assess because of the small number of cases reported in the literature. In cases with orbital involvement, exenteration may be warranted. Radiation may be useful when surgery cannot be tolerated.

[Multiple sebaceous tumors with colon cancer--Muir-Torre syndrome]

The Muri-Torre syndrome is an autosomal-dominant genodermatosis. The criteria of the diagnosis is the occurrence of at least one sebaceous skin tumour and at least one malignant internal tumour. Skin tumours must be considered as very important signs because they may precede visceral malignancies. The authors present the case of a 62 years old man. Three tumours were excised from three different locations of his trunk in the Plastic Surgery Ward of our hospital. The tumours proved to be sebaceous adenoma, sebaceous epithelioma and sebaceous carcinoma by histology. Because of this result, we had conducted a detailed tumour screening which found a non-symptomatic malformation of the proximal colon tract. Histology of the resected colon part revealed adenocarcinoma. With the presentation of this case the authors call attention on the fact, that in case of the diagnosis of a sebaceous skin tumour, careful tumour screening could be lifesaving.

Chronological ageing and photoageing of the human sebaceous gland

The human sebaceous gland undergoes both extrinsic and intrinsic ageing. The latter is associated with morphological changes and alteration in the sebaceous gland activity. The high androgen-dependent sebum secretion in neonates falls during childhood, starts to rise again during puberty and reaches its maximum in young adults. While the number of sebaceous glands remains the same during life, sebum levels tend to decrease after menopause in females, whereas no major changes appear until the eighth decade of life in men. Reduced androgen levels in aged individuals lead to a slow cellular turnover in the sebaceous glands resulting in hyperplasia of the facial sebaceous glands in advanced age. Ultraviolet radiation and immune suppression (cyclosporin A with corticosteroids) represent cofactors for the development of sebaceous gland hyperplasia. Current molecular findings indicate that overexpression of the ageing-associated gene Smad7 and parathormone-related protein correlate with sebaceous gland hyperplasia, whereas c-myc overexpression is associated with enhanced sebum production. On the other hand, down-regulation of the mismatch repair genes hMLH-1 and hMSH-2 may promote the development of sebaceous gland carcinoma. In addition to spontaneous single tumours, sebaceous gland carcinomas have been reported in immune-suppressed transplant recipients (azathiorpine, cisplatin, cyclosporin A) and in association with the Muir-Torre syndrome. Microsatellite instability with a loss of the mismatch repair gene hMSH-2 has been detected in immune suppressed patients and under photo-induced DNA damage. Topical and systemic oestrogens offer treatment options for skin xerosis in menopausal females. A combination of isotretinoin and interferon-alpha may prevent tumour development in patients with Muir-Torre syndrome.

Second malignant neoplasms of the head and neck in survivors of retinoblastoma

Retinoblastoma is a malignant tumor of the embryonic retina. Although it is rare, it is the most common primary eye tumor of childhood. Life expectancy following treatment is now excellent, but survivors who have heritable retinoblastoma face an increased risk of a second malignant head or neck neoplasm. A second neoplasm, which often occurs in the irradiated field of the original tumor, has become the most significant threat to the survival of these patients. We report the case of a young girl who was cured of her retinoblastoma only to later develop a second nonocular tumor that metastasized to the superficial parotid gland. She underwent a superficial parotidectomy and neck dissection, but the malignancy eventually recurred and required further surgery and radiation therapy. In this article, we discuss the etiology, incidence, sites of occurrence, and management options for a second malignant neoplasm in retinoblastoma survivors. The head and neck surgeon must be vigilant in the diagnosis and management of second neoplasms in this patient population because they often occur in irradiated fields; surgical management is important to patient survival.

The U.S. National Research Council's views of the radiation hazards in space

The author was the Chairman of a Task Group on the Biological Effects of Space Radiation formed as a result of discussions between NASA and the U.S. National Research Council's Committee on Space Biology and Medicine - a committee under the U.S. National Research Council's Space Studies Board. The Task Group was asked to review current knowledge on the effects of long-term exposure to radiation in space and to consider NASA radiation shielding requirements for orbital and interplanetary spacecraft. The group was charged with assessing the adequacy of NASA planning for the protection of humans from radiation in space and with making recommendations regarding needed research and/or new shielding requirements. This manuscript is a summary of the findings and recommendations of the Task Group. Beyond the protection of the Earth's atmosphere and its magnetosphere, the exposure to ionizing radiations far exceeds that on Earth. Of all the risks astronauts may face, this one is probably the most straightforward to control - by providing adequate shielding. However, because shielding adds weight, cost and complexity to space vehicles, it is important for designers to have a good quantitative understanding of the true risk and its degree of uncertainty so as not to under- or overshield spacecrafts. The extrapolations from our knowledge of ionizing radiation effects of low linear energy transfer (LET) to the risks from high-atomic-number high-energy energetic (HZE) cosmic rays are very uncertain because the necessary experiments on the effects of such particles have not been carried out and the extrapolation from low-LET to very high-LET has great uncertainties. These uncertainties were enumerated by the Task Group, and the types of experiments needed to minimize the uncertainties were described. The report found that, because of the small amounts of available time for biological research at HZE accelerators, it would take more than a decade of effort to obtain the answers to a narrow set of key questions that would facilitate reduction in risks and identification of the types of shielding needed.

Sebaceous gland carcinoma: a subtle second malignancy following radiation therapy in patients with bilateral retinoblastoma

BACKGROUND

Second primary malignancies are common after bilateral retinoblastoma; their estimated incidence has been as high as 51% 50 years after diagnosis. Fifteen patients who developed sebaceous gland carcinoma after radiation therapy have been reported in the literature, five of whom were treated for bilateral retinoblastoma.

METHODS

The authors conducted a retrospective chart review of patients treated for bilateral retinoblastoma at Duke University Medical Center who later developed sebaceous gland carcinoma.

RESULTS

This article reports two patients who developed sebaceous gland carcinoma after radiation therapy for bilateral retinoblastoma.

CONCLUSIONS

Delay in diagnosis is often associated with sebaceous gland carcinoma. Because high mortality is observed with metastatic disease, the recognition of this association is important for anyone who follows patients with a history of bilateral retinoblastoma or prior cranial radiation therapy.

Squamous cell and adnexal carcinomas of the skin

The diagnosis and treatment of adnexal cancers continues to pose a challenge to a wide range of clinicians. The diseases are a diverse lot, owing to the wide range of skin structures and large surface area. Early recognition and treatment are key to improved outcomes. Education of the patients as to their role in their care, especially early detection, is also of crucial importance. Further study may yield information to improve diagnosis and treatment.

The Muir-Torre syndrome: a 25-year retrospect

The Torre or Muir-Torre syndrome consists of certain types of sebaceous neoplasms of the skin, with or without keratoacanthomas, and one or more low-grade visceral malignancies in the absence of other predisposing factors. The sebaceous tumors are relatively uncommon or rare: sebaceous adenoma, sebaceous epithelioma, basal cell epithelioma with sebaceous differentiation, and sebaceous carcinoma. Sebaceous hyperplasia and hamartomas such as nevus sebaceus of Jadassohn, with or without a sebaceous epithelioma within it, are not a defining part of this syndrome. Sebaceous hyperplasia is common in elderly light-complexioned people with or without this syndrome. Nevus sebaceus of Jadassohn is not rare and is predisposed to the development of other neoplasms within it, including occasionally a sebaceous epithelioma. Colonic polyps are frequently present. Muir-Torre syndrome requires recognition because affected patients are at risk of multiple primary malignancies. The skin lesions may be the first sign of this syndrome, although more often its cutaneous signs follow the diagnosis of at least the first visceral malignancy. The Muir-Torre syndrome portends the greater possibility of a favorable prognosis than might be anticipated otherwise because the visceral cancers are usually low-grade malignancies. However, they are often multiple, so identifying such patients will affect their management in a few ways. Because these indolent visceral malignancies tend to permit prolonged survival, even metastatic disease may respond well to aggressive surgical treatment. The sebaceous cancers in this syndrome, like the visceral malignancies, are less aggressive than their counterparts unassociated with this syndrome. Because this syndrome is inherited in an autosomal dominant manner, identifying one patient means delineating an entire family, which should be investigated. This syndrome may be caused by a defective mismatch DNA repair gene.

Sebaceous tumors arising in ovarian dermoid cysts

The clinicopathologic features of five cases of sebaceous tumors arising in ovarian dermoid cysts and of three previously reported cases are reviewed. They occurred in women with an average age of 58 years and were classified as sebaceous adenoma (five cases), basal cell carcinoma with sebaceous differentiation (two cases), and sebaceous carcinoma (one case). Follow-up information was available for all cases. One patient with basal cell carcinoma with sebaceous differentiation had a pelvic recurrence 2 1/2 years after diagnosis. In no other case did the sebaceous tumor recur or metastasize during follow-up periods of 1 to 6 years. One patient died of a squamous cell carcinoma that arose in the same dermoid cyst as the sebaceous tumor. These tumors represent a rare form of monodermal neoplasia in dermoid cysts.

Sebaceous and meibomian carcinomas of the eyelid. Recognition, diagnosis, and management

Sebaceous carcinoma of the eyelid is frequently misdiagnosed clinically and histopathologically. The tumor may present as a lid mass, recurrent chalazion, or diffuse unilateral blepharoconjunctivitis. Fifty percent of cases are misdiagnosed, often by an inexperienced general pathologist interpreting the initial biopsy. Frozen-section monitoring of surgical margins has been reported unreliable in 25% of cases. Mohs surgery is also unreliable in cases where there is pagetoid intraepithelial spread or skip lesions. This tumor may spread regionally into the lacrimal secretory and excretory systems, to regional lymph nodes, and rarely disseminate hematogenously. Guidelines for management are discussed.

Treatment of extensive adenoma sebaceum with a carbon dioxide laser

This case report documents the successful removal of a sizable and symptomatic adenoma sebaceum from the face, nose, and palate with the carbon dioxide laser.

Sebaceous adenomas and keratoacanthomas in a patient with malignant lymphoma. A new form of Torre's Syndrome

A women with non-Hodgkin's lymphoma developed numerous sebaceous adenomas over the face, neck, and trunk. The association of multiple sebaceous adenomas with underlying visceral malignancy was first described by Torre in 1968 and is known now as Torre's syndrome. The present case, to the best of our knowledge, is the first report of hematologic malignancy associated with Torre's syndrome.

Tuberous sclerosis. Report of nine cases and a review

Tuberous sclerosis is characterized by epilepsy, mental retardation and adenoma sebaceum. Seizures and mental retardation were the presenting complaints in the nine cases presented here; however, a variety of clinical manifestations of the disease exist. Early diagnosis facilitates genetic counseling.

Sebaceous carcinoma of the eyelid following radiation therapy

This paper reports a case of a 12-year-old boy with fatal sebaceous carcinoma originating from the eyelid. The carcinoma developed 11 years after curative radiation therapy for bilateral retinoblastoma. Sebaceous carcinomas associated with previous irradiation are uncommon, and only five such cases have been published. Three of the patients were treated for benign disorders and the two other cases followed radiation therapy for bilateral retinoblastoma. Second malignant neoplasms in patients with bilateral retinoblastoma are thought to be related to a genetically inherited predisposition to the development of second malignant tumors. Radiation therapy is claimed to be an inducing factor in many cases but malignant neoplasms are also found in areas distant from the portals of irradiation as well as in patients not irradiated. Most of the secondary tumors were sarcomas, and usually osteogenic sarcomas.

Sebaceous gland carcinoma of the eyelid

A 37-year old woman had received multiple radiation treatments between the ages of 6 months and 15 years for an extensive cavernous hemangioma of the left side of the face. At the age of 27 years, a biopsy specimen from a lesion of the left buccal commissure disclosed squamous cell carcinoma arising in chronic radiodermatitis. Multiple cutaneous lesions were excised surgically, and extensive skin grafting of the left side of the face was performed. At the age of 35, she developed a tumor of the left upper and lower eyelids that extended into the orbit, which proved to be a sebaceous gland carcinoma. Following left orbital exenteration, the tumor promptly recurred in the socket. The patient died with widespread metastatic lesions nine months after exenteration. This case, which, to our knowledge, represents the fourth example of postradiation sebaceous gland carcinoma of the eyelids, differs from the previously reported cases in that the radiation therapy had been given for a benign cutaneous condition.

Hamartoma and renal transplant implications

A 19-year-old woman with tuberous sclerosis, bilateral renal hamartomas and polycystic kidneys required separate nephrectomies for severe hemorrhages 6 months apart. The case is presented, the diagnoses of the disease in relation to a negative family history are considered and the importance of early diagnosis in a potential transplant recipient and the use of leukocyte-free transufusions are discussed.

Tuberous sclerosis with striking renal involvement in a family

We describe five cases of tuberous sclerosis in members of one family, all having renal involvement but with differences in age of onset and mode of presentation. Clinical, laboratory, and pathologic features helpful in diagnosing this condition and in distinguishing it from polycystic kidney disease and renal neoplasms are stressed. Tuberous sclerosis should always be considered in differential diagnosis of patients with multiple cystic renal lesions, particularly when age of onset of symptoms ranges from infancy to adult life in different members of one family. Absence both of specific glomerular or tubular lesions in ultrastructure and of major abnormalities in renal tubular function supports the existing concept that replacement of nephrons by hamartomatous lesions is the cause of progressive renal failure.

Multiple sebaceous gland tumours associated with polyposis of the colon and bony abnormalities

The cases are presented of two siblings with multiple cutaneous tumours associated with adenomatous polyps of the colon and bony abnormalities. In one patient an adenocarcinoma of the colon supervened, and there was a history of adenocarcinoma of the colon without the presence of other abnormalities in a third sibling. Clinically the sebaceous tumours resembled sebaceous hyperplasia, but histologically they exhibited features of sebaceous adenoma.The association of a variety of multiple soft tissue tumours, particularly epidermal cysts, with polyposis of the colon and bony abnormalities is well recognized. However, multiple solid sebaceous tumours have not been reported previously as a feature of this syndrome. They should in future alert the physician to the possible presence of multiple polyposis of the colon in affected individuals and immediate relatives.