Mr LA has long been troubled with actinic damage to his skin, especially his face. He has had many squamous cell carcinomas (SCCs) removed and many solar keratoses managed. On this occasion Mr LA had two actinic lesions on his left cheek that failed to respond to cryotherapy. A biopsy of each site produced a surprise. Histology of the superior lesion revealed sebaceous carcinoma. This is an uncommon yet aggressive cutaneous malignancy derived from sebaceous glands. The 5 year survival rate is 60-70%. The tumour was widely excised with a minimum 10 mm margin. A multidisciplinary approach resulted in a decision not to proceed to adjunctive radiotherapy. The wound was well healed by 8 weeks. Four years on there is no sign of local or regional recurrence.