A 69-year-old man presented to our institution in June 2012. Eleven years earlier, in September 2001, he had been diagnosed as having sebaceous carcinoma of the left caruncle, which was surgically excised by a Mohs surgeon with reportedly negative margins. Since 2001, the patient had undergone ocular examination and magnetic resonance imaging annually and scans with results that had been negative for recurrence. However, examination in March 2012 revealed an enlarged left submandibular lymph node, which was initially treated with oral antibiotics with no improvement. The node was surgically excised, and pathologic examination confirmed metastatic sebaceous carcinoma with extracapsular extension. The patient was referred to our institution for further evaluation and treatment.