Letter to the Editor
To the Editors:
In a recent article, Kazakov et al1 described 5 cases of sebaceous neoplasms with architectural features of benignancy and cytological attributes of malignancy and stated that “the classification of such lesions as sebaceoma (with atypia) or sebaceous carcinoma remains unresolved.” This opinion is in contrast to that of Resnik,2 who reviewed the article and glass slides of the 5 neoplasms under discussion and did not agree with the authors' assessment that these lesions cannot be classified as either sebaceoma or sebaceous carcinoma. In Resnik's opinion, 4 of the 5 cases represent sebaceous carcinoma and 1 sebaceoma. Although we agree with Resnik that the lesions presented by Kazakov et al1 can be classified, we believe most of these lesions, if not all, are best classified as sebaceous carcinoma in situ rather than sebaceous carcinoma (the term carcinoma when used unmodified generally refers to invasive carcinoma). As illustrated by Kazakov et al1 in the article, all the lesions show the following histopathologic features: (1) architectural findings of confinement, namely, well circumscribed with smooth borders, indicating the neoplastic cells still confined in epithelium (sebaceous gland, sebaceous duct, and/or follicular epithelium); and (2) cytological attributes of malignancy, such as presence of nuclear atypia, increased mitotic figures including atypical ones and necrosis in the form of single cells or en masse. These histopathologic findings fit the criteria of carcinoma in situ, namely, a malignant epithelial neoplasm confined in the epithelium of origin, which was introduced and defined by Broders3 in 1932. Clinically, because they are sebaceous carcinoma in situ, they will neither recur nor metastasize after simple complete surgical excision.
Of note, others may classify these lesions presented by Kazakov et al1 as sebaceous adenoma. It is worthwhile to mention that in an article published in 1998, Nussen and Ackerman4 revised a previously held concept and stated that the so-called sebaceous adenoma is not a benign neoplasm but sebaceous carcinoma. This notion was upheld by Ackerman et al5 in another article published in 1999 and subsequently in the 2nd edition of a book devoted to neoplasms with sebaceous differentiation published in 2009.6 In a recent article, Chen7 agreed with Ackerman and coauthors' notion that the so-called sebaceous adenoma is not a benign neoplasm and, for the same reasons stated above, proposed a different view asserting that the so-called sebaceous adenoma is sebaceous carcinoma in situ.
Furthermore, we believe that carcinoma in situ is an unifying concept and can be applied to a variety of organ systems. It has been well established and widely used in tumor pathology of the breast,8 which consists of modified apocrine glands. We see no reason why it can not be applied to neoplasms of sebaceous gland.
Jill M. Kramer, DDS, PhD*
Sheng Chen, MD, PhD†
*Department of Dental Medicine, Division of Oral and Maxillofacial Pathology, Long Island Jewish Medical Center, New Hyde Park, NY
†Department of Pathology, Long Island Jewish Medical Center, New Hyde Park, NY
1. Kazakov DV, Kutzner H, Spagnolo DV, et al. Discordant architectural and cytologic features in cutaneous sebaceous neoplasms - a classification dilemma: report of 5 cases. Am J Dermatopathol
2. Resnik KS. Classifying neoplasms with sebaceous differentiation-a reviewer's comments. Am J Dermatopathol
3. Broders AC. Carcinoma in situ
contrasted with benign penetrating epithelium. JAMA
4. Nussen S, Ackerman AB. Sebaceous “adenoma” is sebaceous carcinoma. Dermatopathol: Pract Conc
. 1998;4:5-14. Available at: http://www.derm101.com
. Accessed January 17, 2010.
5. Ackerman AB, Nussen-Lee S. Neoplasms in all organs of Muir-Torre syndrome are carcinomas: sebaceous carcinomas and squamous-cell carcinomas (keratoacanthomas) in skin and adenocarcinomas, squamous-cell carcinomas, and transitional-cell carcinomas in internal organs. Dermatopathol: Pract Conc
. 1999;5:312-318. Available at: http://www.derm101.com
. Accessed January 17, 2010.
6. Ackerman AB, Nussen-Lee S. Tan MA. Histopathologic Diagnosis of Neoplasms with Sebaceous Differentiation. Atlas and Text
. 2nd ed. New York, NY: Ardor Scribendi; 2009.
7. Chen S. A different view: sebaceous adenoma is sebaceous carcinoma in situ. Dermatopathol: Pract Conc
. 2010;16:16. Available at: http://www.derm101.com
8. Rosen PP. Rosen's Breast Pathology
. 3rd ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2009.