Background/aims Sebaceous carcinoma (SC) is a rare cancer with periocular predilection. Studies focused on patterns and timing of nodal metastasis are scarce.

Our aim is to report patterns of regional nodal metastasis in patients with eyelid SC, including results of sentinel lymph node biopsy (SLNB).

Methods All consecutive patients with eyelid SC treated during 1999–2023 were retrospectively reviewed.

All subjects had standard of care surgery for eyelid SC and regional lymph node evaluation using physical examination and ultrasonography (US) at baseline and during the surveillance period. 38 patients with negative findings on US had SLNB to rule out microscopic metastasis.

The frequency and timing of lymph node metastasis, the SLNB positivity rate, management of nodal metastasis, overall and disease-specific survival were analysed.

Results A total of 138 patients were included. 30 patients (22%) had lymph node metastasis: 15 patients were diagnosed at the time of initial diagnosis of eyelid SC; 18 patients developed nodal metastasis during the follow-up period, at a median of 12 months (range, 1–132). Of 38 patients, 5 (13%) had a positive SLNB. Management of nodal metastasis entailed surgical resection of the involved nodal basins in 27 patients; 20 had adjuvant radiotherapy and 7 had adjuvant concurrent chemoradiation. In patients with nodal metastasis, the 2-year and 5-year disease-specific survival rates were 87.5% and 75.4%, respectively.

Conclusions One-half of the patients with eyelid SC with nodal metastasis had negative findings at initial presentation but developed nodal metastasis during follow-up, highlighting the importance of continued lymph node surveillance.