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Fig. 1. Tumor recurrence in left upper lid

Fig. 2. Histology of the specimen from the original surgery

A 70-year-old female presented with tumor recurrence in her left upper eyelid. She underwent surgical excision with frozen-section control of margins and reconstruction.

1.	What is the most likely diagnosis?
	c -- sebaceous gland carcinoma The histologic photo shows invasive sebaceous carcinoma cells displaying their typical basophilic and fomay appearance.
2.	During initial biopsy, the surgical specimen should be sent:
	a -- fresh When sebaceous gland carcinoma is suspected, biopsy specimens should be sent fresh to accommodate lipid stains such as Sudan black or oil red O to confirm the diagnosis.  The lipid is lost if the specimen is sent in other fixatives and does not allow the pathologist to perform confirmatory staining.
3.	The reconstructive procedure used in this case may have been:
	b -- Cutler-Beard procedure This patient lost the entire width of her upper lid.  A Hughes procedure would be utilized to reconstruct a similar large defect involving the lower eyelid. Fig. 3. The full width of the left upper lid has been excised.  Fig. 4. A Cutler-Beard flap.  Lid sharing from lower to upper.