Sebaceous Gland Carcinoma-Reply

In Reply.  —The scientific evidence for Drs Boynton and Searl's objection to our statement is not apparent, either in their letter or in the literature they cite. The question of leaving epithelium with pagetoid change has simply not been addressed in all the previous publications we reviewed. Most authors have referred to total removal of epithelium with pagetoid change. Pagetoid epithelial involvement should be considered a premalignant condition, as in other conditions such as dysplasia, carcinoma in situ, and acquired melanosis.In the case of malignant melanoma arising in acquired melanosis, the preferred treatment now is local excision of the melanoma and close observation of the acquired melanosis—not exenteration. Rao et al¹ noted that the prognosis of sebaceous gland carcinoma was worse if pagetoid change was present, but delay in diagnosis because of treatment for blepharoconjunctivitis could be a factor.In our series of 40 sebaceous gland carcinomas, one