Sebaceous carcinoma and systemic chemotherapy
A 21-year-old male presented to the head and neck oncology clinic with a history of recurrent lesion in left occipital region. He had a swelling in the left occipital region 1 year back. Although the swelling had been largely asymptomatic, patient sought medical opinion at a local hospital, due to its rapidly growing size and the presence of ulceration. The lesion was mobile with small area of ulceration in center. According to the CT scan findings, there was a soft tissue lesion 4.2 × 2.5 cm2 in subcutaneous tissue in posterior occipital region with no bony erosion or intracranial extension and a diagnosis of sebaceous cyst was made. Excision of the swelling was done but specimen was not sent for histopathological examination (HPE). Again, patient developed recurrence at the local site after 4 months. This was followed by excision of the swelling and this time the specimen was sent for HPE. The report came as sebaceous carcinoma and the patient was kept under follow up. After 3 months, patient again developed local recurrence and this time he sought medical advice at our oncology clinic. The swelling was 2 × 2 cm2 in size, subcutaneous, and mobile present at previous scar site in left occipital region. CT scan was suggestive of 2.1 × 2 × 1 cm2 lesion with subtle outer cortex erosion. Wide excision of the lesion was planned. Chest X-ray done for pre-anaesthetic check up was suggestive of nodular opacity in right middle lobe of lung. Following which, CT thorax was done. It was suggestive of multiple B/L lung opacities [Figures and ]. FNAC of the swelling at left occipital region and the bsiopsy of lung nodule [] both were sebaceous carcinoma. The patient underwent local excision with local rotation flap followed by systemic chemotherapy for lung metastasis. The patient received six cycles of 3 weekly paclitaxel (175 mg/m2) and carboplatin (Area under curve-5). Patient tolerated the chemotherapy well without any grade III or IV toxicities. Post three cycles of chemotherapy, the lung metastases had completely resolved on CT scan and patient was symptomatically better. CT scan done 6 months after completion of chemotherapy [Figures and ] revealed that patient was still in complete remission. The primary site as well was controlled and the patient was doing well.