Primary sebaceous gland carcinoma of the bulbar conjunctiva without involvement of eyelid: A clinical dilemma

Sebaceous gland carcinoma usually arises from the meibomian or Zeis glands within the eyelid, but tumor arising primarily from the conjunctiva, especially bulbar conjunctiva, is a rarity. We hereby report a case of a 50-year-old female who presented with a painless mass in the inferior limbus, encroaching the cornea and hanging over the lower eyelid without involving it. Imprint cytology was suggestive of adenosquamous carcinoma. Management consisted of wide local excision, cryotherapy to tumor bed, and topical 5-fluorouracil (5-FU) 1% preoperatively and postoperatively. Histopathologic analysis was in favor of sebaceous gland carcinoma. This case suggests that although sebaceous gland carcinoma commonly originates as a lid tumor, it can present as a bulbar conjunctival mass. Topical 5-FU is a viable and efficient cost-effective alternative for neo-adjuvant and adjuvant treatment of sebaceous gland carcinoma.