Long-Term Remission of an Aggressive Sebaceous Carcinoma following Chemotherapy
A 69-year-old Caucasian male with a history of multiple premalignant skin lesions presented with a solitary 15-mm erythematous nodular dermal lesion on the vertex. A wide surgical excision was performed and revealed a poorly differentiated SC. In the following months, 2 new dermal lesions consecutively appeared in the right occipital area. As the local resections were microscopically incomplete, a strategy including wide surgical excision with skin graft reconstruction and right posterior cervical lymphadenectomy was adopted. The pathological examination confirmed that the SC had spread to the lymph nodes and that positive tumor margins were still present in the skin and gave rise to multiple new recurrences. More excisions were performed over the next few months, each being followed by more recurrences within a month's time.\nIrradiation in the form of tomotherapy was then proposed. A total of 66 Gy was applied to the occipital and right retroauricular areas, and 52.8 Gy to the cervical lymph nodes. No benefit was observed after radiotherapy and the lesions continued to grow. A physical examination performed at that time revealed an excoriated hemorrhagic nodular dermal lesion (3 × 4 cm) in the central parieto-occipital region and a second nodular lesion (3 × 2 cm) in the right retroauricular area (fig. ). Magnetic resonance imaging of the head showed 3 subcutaneous masses (3 × 2 cm) in the occipital area, the right retroauricular region and the right parietal zone (fig. ). No intracerebral lesions were observed. Further radiographic studies indicated the presence of lymph node metastases in the absence of distant metastases.\nAt this point, chemotherapy was initiated using a combination of 5-fluorouracil (750 mg/m2/day for 4 days), cisplatin (100 mg/m2) and docetaxel (75 mg/m2) every 3 weeks. A significant clinical improvement (>50% reductions in the size of the lesions) was already seen after the first cycle. Due to myelosuppression, the decision was made to remove docetaxel from the regimen. After a total of 4 chemotherapy cycles, all lesions had disappeared. Treatment was subsequently maintained with single-agent capecitabine (1,000 mg/m2/day) on days 1–10 every 21 days. A clinical and radiographic follow-up at >20 months confirmed that complete remission had persisted (fig. , fig. ).