| disease | Meibomian Gland Carcinoma |
| alias | Meibomian Gland Carcinoma |
Meibomian gland carcinoma is a malignant tumor originating from the sebaceous glands. It has a high incidence rate, ranking second among malignant eyelid tumors. In terms of gender, it is more common in women than in men. Regarding the site of occurrence, it affects the lower eyelid more frequently than the upper eyelid. The degree of malignancy varies significantly depending on the subtype. Low-grade malignancies grow slowly over many years, while high-grade malignancies progress rapidly, leading to early metastasis. Therefore, special attention should be paid to recurrent chalazion-like lesions in individuals over 40 years of age.
bubble_chart Clinical Manifestations
In the early stages, there are often few noticeable symptoms. Local manifestations include subcutaneous nodules that are hard and not adherent to the skin, resembling chalazion. Some cases are misdiagnosed as chalazion and recur after surgical excision. As the mass continues to grow, yellow nodules may become visible through the conjunctival membrane, with an uneven surface, eventually forming ulcers and developing cauliflower-like masses that bleed easily upon touch. In cases with lower differentiation, metastasis to the preauricular and submandibular lymph nodes can occur earlier via lymphatic vessels.
The condition primarily occurs in elderly patients, with a prolonged disease course and is more common in women, typically affecting the upper eyelids. A history of chalazion episodes is often present during the disease progression, and yellowish-white, caseous tumor tissue can be observed at the lesion site.
bubble_chart Treatment Measures
Untreated cases can lead to death due to ulcer bleeding, infection, or exhaustion. Radiotherapy is not very sensitive to this type of cancer, so it can only be used as an adjuvant. Surgical treatment is relatively more effective. For differentiated types, if the lesion is small and does not extend beyond the eyelid itself, local excision alone is sufficient.
As long as the tumor is completely removed during surgery, recurrence is rare.
This cancer needs to be clinically differentiated from the following three lesions:
1. Chalazion
(1) Chalazions are mostly located far from the eyelid margin, and those entirely situated at the margin are relatively rare. In contrast, cancerous tissue tends to spread along the meibomian gland ducts, so involvement of the eyelid margin is more common.
(2) Morphologically, these two are very similar in the early stages. However, in cancer, the conjunctiva over the lesion is often rougher, and yellow spots may sometimes be observed. In chalazions, the conjunctiva usually appears bluish-gray or slightly congested and is generally smooth.
(3) When a chalazion is incised, it typically contains a gelatinous substance. If secondary infection and liquefaction occur, a grayish-yellow fluid may ooze from the incision. In cancer, the tissue is hard, brittle, and yellowish-white. After spontaneous rupture, a chalazion may form polypoid granulation tissue, unlike the rough, cauliflower-like mass seen in cancer.
(4) During youth, glandular secretion is vigorous, making chalazions more likely to occur. In old age, glands tend to atrophy, and secretory function declines, so chalazions are relatively rare in the elderly. Therefore, when recurrent chalazions appear in older individuals, the possibility of meibomian gland carcinoma must be considered. It is advisable to perform a biopsy on the excised lesion to clarify its nature and avoid misdiagnosis.
2. Squamous cell carcinoma: Pathologically, meibomian gland carcinoma closely resembles squamous cell carcinoma, but clinically, the two are significantly different.
(2) Early meibomian gland carcinoma closely resembles a chalazion, while early squamous cell carcinoma appears as a nevus or papilloma on the skin surface. In advanced stages, patients with meibomian gland carcinoma tend to be older than those with squamous cell carcinoma.
(3) Meibomian gland carcinoma is more common in women than in men, whereas squamous cell carcinoma is far more prevalent in men. Both occur in older individuals, but meibomian gland carcinoma patients are generally older.
(4) Both can metastasize, but the metastasis rate of squamous cell-type meibomian gland carcinoma (60%) is higher than that of squamous cell carcinoma (10%).
3. Basal cell carcinoma: Based solely on pathology, meibomian gland carcinoma can easily be misdiagnosed as basal cell carcinoma, so clinical features should be considered for differentiation.
(1) Meibomian gland carcinoma is deeper, situated between the skin and conjunctiva, while basal cell carcinoma usually originates from the skin epidermis and is more superficial, often located near the inner canthus of the lower eyelid.
(2) Early meibomian gland carcinoma resembles a chalazion, while in advanced stages, it forms a hard, lobulated walnut-like mass beneath the skin. Upon ulceration, yellowish-white cancerous tissue is exposed, resembling a cauliflower-like growth. Basal cell carcinoma initially resembles a nevus, but in advanced stages, it forms a typical rodent ulcer with a hard base and rolled edges.
(4) The metastasis rate of basal cell-type meibomian gland carcinoma is about 40%, whereas cutaneous basal cell carcinoma rarely metastasizes.
