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Alnehlaoui F, Elhadidi NML, Fwakhrji S, Shikare SV, Alhammadi MH, Guraya SY. Primary cutaneous mucinous carcinoma of the scalp masquerading as a benign dermatological mass - A case report. Int J Surg Case Rep 2024; 114:109175. [PMID: 38176277 PMCID: PMC10800677 DOI: 10.1016/j.ijscr.2023.109175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Primary cutaneous mucinous carcinoma (PCMC) is a rare low-grade malignant neoplasm derived from the sweat glands. Local recurrence of PCMC occurs frequently, but these lesions rarely metastasize. Due to the absence of classical demographic and clinical characteristics, PCMCs masquerade as sebaceous cyst, lipoma, pilomatrixoma, chalazion, or squamous cell carcinoma. This misdiagnosis frequently leads to incomplete surgical excision which necessitates further surgical therapy for a curative intent. CASE PRESENTATION We present a case of PCMC in a 45-year-old woman which presented as a slow- growing and symptomless nodule in the scalp. After clinical evaluation, the patient had a typical surgical excision for a benign-looking lesion. Histological evaluation of the specimen confirmed a localized PCMC in the scalp with involved surgical margins. CLINICAL DISCUSSION A thorough oncological assessment by PET-CT scan and radionuclide scintigraphy was performed. Later, a wide local excision using a gamma probe for intra-operative radionuclide localization of the tumor area and sentinel lymph nodes was done. CONCLUSION The patient did not have any regional or distant metastases and remained stable at the time of reporting this case.
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Affiliation(s)
- Fadi Alnehlaoui
- Department of Surgery and Surgical Oncology, Oriana Hospital Sharjah, United Arab Emirates
| | | | | | | | | | - Salman Yousuf Guraya
- College of Medicine University of Sharjah, Visiting Surgeon NMC Royal Hospital Sharjah, United Arab Emirates.
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Lewis AL, Shi KY, Tate JA, Nijhawan RI. Locally Advanced Mucinous Carcinoma Treated With Mohs Micrographic Surgery. Dermatol Surg 2023; 49:801-803. [PMID: 37249514 DOI: 10.1097/dss.0000000000003836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Abigail L Lewis
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kevin Y Shi
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jesalyn A Tate
- Department of Dermatology, The University of Kansas Medical Center, Kansas City, Kansas
| | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
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Current Treatment Options for Cutaneous Adnexal Malignancies. Curr Treat Options Oncol 2022; 23:736-748. [DOI: 10.1007/s11864-022-00971-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/03/2022]
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Shah DS, Homer NA, Epstein A, Durairaj VD. Simultaneous presentation of orbital mantle cell lymphoma and endocrine mucin-producing sweat gland carcinoma. Orbit 2021; 41:509-513. [PMID: 33657963 DOI: 10.1080/01676830.2021.1894583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Mantle cell lymphoma is a rare malignancy to present in the orbit, comprising only 1-5% adnexal lymphomas. Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is an equally uncommon adnexal tumor of sweat gland origin that may present on the eyelid. Herein we present a case of a 77-year old man with no previous cancer history who presented with painless progressive left globe proptosis and an enlarging left upper lid margin lesion, ultimately determined upon biopsy to be simultaneous orbital mantle cell lymphoma with systemic involvement and isolated eyelid EMPSGC. The pathogenesis, clinical manifestation, and management for each rare disease entity are reviewed and concept of collision tumors is discussed.
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Affiliation(s)
- Darsh S Shah
- Department of Ophthalmology, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Natalie A Homer
- Department of Ophthalmology, UC Davis, Sacramento, California, USA
| | | | - Vikram D Durairaj
- Department of Ophthalmology, Dell Medical School, University of Texas at Austin, Austin, Texas, USA.,TOC Eye and Face, Austin, Texas, USA
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Aryasit O, Preechawai P, Hajeewaming N. Clinicopathologic Characteristics and Predictors Affecting Survival Outcome of Eyelid Malignancy. J Craniofac Surg 2019; 30:1516-1519. [PMID: 31299757 DOI: 10.1097/scs.0000000000005341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to determine the clinicopathologic characteristics and evaluate the prognostic factors in eyelid malignancies. This was a retrospective, comparative, case series of 70 patients with eyelid malignancies. The mean age at diagnosis was 72.0 years (range 30.5-93.0 years) with 64.3% female. The 2 most common histologic types were basal cell carcinoma (BCC) followed by sebaceous gland carcinoma (SGC). In total, 47.1% of the malignancies were located in the lower eyelid and the majority of tumor (T) category was T1. The authors assessed the disease-specific survival rates of 64 surgical patients using Kaplan Meier curves. Univariate and multivariate analyses identified the predictors associated with disease-specific survival. Of the 64 surgical patients, 4 had regional nodal metastasis (2 SGC, 1 squamous cell carcinoma [SCC], and 1 adenocarcinoma) and distant metastasis at diagnosis was in 3 patients (2 SGC and 1 malignant melanoma [MM]). Six patients died of disease during follow-up. The 5-year disease-specific survival in BCC, SCC, and SGC were 100%, 100%, and 64.8%, respectively. The predictive factors affecting worse disease-specific survival on multivariate models were T4 category (adjusted hazard ratio [aHR] 14.15, P = 0.022) and tumor recurrence (aHR 6.84, P = 0.045). In conclusion, BCC was the most common eyelid malignancy in southern Thailand followed by SGC. In this study, T4 category and tumor recurrence were the most important prognostic factors in eyelid malignancies.
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Affiliation(s)
- Orapan Aryasit
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
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6
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Motta M, Alongi F, De Martin E, Fiorino C, Maggiulli E, Rigoni L, Landoni C, Broggi S, Deli AM, Calandrino R, Di Muzio N. Helical Tomotherapy for Scalp Recurrence of Primary Eccrine Mucinous Adenocarcinoma. TUMORI JOURNAL 2018; 95:832-5. [DOI: 10.1177/030089160909500632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Primary cutaneous mucinous carcinomas originating from sweat glands are rare tumors with patterns of spread that are difficult to predict. We present a case of a five times recurring eccrine mucinous adenocarcinoma of the scalp, previously treated with surgery and adjuvant radiation therapy. After magnetic resonance imaging (MRI) and 18F-fluoro-2-deoxyglucose positron-emission tomography/computed tomography (18FDG-PET/CT), which documented local recurrence, the patient was considered eligible for salvage irradiation of the scalp. We decided to use helical tomotherapy, which combines conformity of dose delivery with the possibility of daily control of the setup accuracy. Forty gray (2Gy/fraction) to the planning target volume and 50 Gy (2.5Gy/fraction) to the biological target volume defined on the basis of 18FDGPET/CT was prescribed with a simultaneous integrated boost technique. After 12 fractions the patient was submitted to intermediate evaluation by 18FDG-PET/CT, which showed a partial response to the treatment. After 2, 4, 8, and 12 months, 18FDG-PET/CT showed a complete metabolic local response. This experience suggests a possible role of 18FDG-PET/CT-guided helical tomotherapy as an alternative to repeated and frequently demolitive surgery approaches.
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Affiliation(s)
- Micaela Motta
- Radiotherapy Department, Scientific Institute San Raffaele, Milan
| | - Filippo Alongi
- Radiotherapy Department, Scientific Institute San Raffaele, Milan
- IBFM-CNR (Istituto di Bioimaging e Fisiologia Molecolare-Consiglio Nazionale delle Ricerche); Responsabile Radioterapia Intraoperatoria, LATO HSR-Giglio, Cefalù
| | | | | | | | - Lara Rigoni
- Radiotherapy Department, Scientific Institute San Raffaele, Milan
| | - Claudio Landoni
- Nuclear Medicine Department, Scientific Institute San Raffaele, Milan, Italy
| | - Sara Broggi
- Medical Physics, Scientific Institute San Raffaele, Milan
| | - Aniko Maria Deli
- Radiotherapy Department, Scientific Institute San Raffaele, Milan
| | | | - Nadia Di Muzio
- Radiotherapy Department, Scientific Institute San Raffaele, Milan
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Tak MS, Cho SE, Kang SG, Kim CH, Kim DW. Primary Cutaneous Mucinous Carcinoma of the Eyelid. Arch Craniofac Surg 2017; 17:176-179. [PMID: 28913279 PMCID: PMC5556810 DOI: 10.7181/acfs.2016.17.3.176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 07/05/2016] [Accepted: 07/10/2016] [Indexed: 11/11/2022] Open
Abstract
Primary cutaneous mucinous carcinoma (PCMC) is a rare low-grade malignant neoplasm derived from the eccrine glands. PCMC most commonly arises in the head and neck, with the eyelid being the most common site of origin. This case report describes a 51-year-old male with a painless, pigmented superficial nodular lesion over his right lower eyelid. The lesion was considered to be benign, and the initial treatment was simple excision with a 3-mm margin. However, histologic examination revealed the diagnosis of PCMC, and the patient underwent re-excision of the tumor site with an additional 3-mm margin from the initial scar. Histologic study of this second margin was free of any malignant cells. The patient experienced no postoperative complication or recurrence after 2 years. In our case, the skin lesion had benign morphologic findings and was strongly suspected to be a benign mass. Physicians should be aware of this tumor and be able to differentiate it from benign cystic or solid eyelid lesions.
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Affiliation(s)
- Min Sung Tak
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seong Eun Cho
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sang Gue Kang
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Chul Han Kim
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Dong Won Kim
- Department of Pathology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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8
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Epidemiology and Prognosis of Primary Periocular Sweat Gland Carcinomas. Ophthalmic Plast Reconstr Surg 2017; 33:101-105. [DOI: 10.1097/iop.0000000000000658] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Beteddini OSA, Sheikh S, Shareefi F, Shahab R. Primary mucinous adenocarcinoma of the scalp: A case report and literature review. Int J Surg Case Rep 2015; 10:241-4. [PMID: 25708135 PMCID: PMC4429839 DOI: 10.1016/j.ijscr.2015.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/31/2015] [Accepted: 02/02/2015] [Indexed: 11/04/2022] Open
Abstract
Primary mucinous adenocarcinoma of the skin is a rare tumour. Distinguishing between this primary neoplasm and the more frequently encountered metastatic mucinous deposits on the skin from primaries elsewhere is a diagnostic dilemma. Because of the high rate of recurrence, adequate excision with wide margins is advocated. Moh’s micrographic surgery can be a particularly advantageous treatment modality in this setting. Proper patient counselling and follow-up are important in treating this low-grade, indolent and frequently recurring tumour.
Introduction Primary mucinous adenocarcinoma or mucinous eccrine carcinoma of the skin is a rare malignant neoplasm showing predilection to the head and neck. Distinguishing between these primary neoplasms and the more frequent metastatic mucinous deposits on the skin from primaries in the breast and gastrointestinal tract constitutes a diagnostic dilemma. Presentation of case We report a case of a 61-year-old lady who presented with a slow-growing, painless scalp nodule. Upon excision, it was diagnosed as “primary mucinous adenocarcinoma”. An extensive work-up in search for another primary tumour failed to show a primary malignancy elsewhere and the diagnosis of a primary eccrine mucinous adenocarcinoma of the skin was rendered. Discussion A review of the literature on this entity is presented, discussing diagnostic challenges and therapeutic options that of interest to surgeons, pathologists and dermatologists. Conclusion These tumours are indolent and low-grade, with a tendency for local, sometimes multiple, recurrences. Proper patient counselling and follow-up are important in treatment. Sound collaboration between clinicians and pathologists, for good therapeutic results, is of utmost importance.
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Affiliation(s)
- Osama S Al Beteddini
- Surgery Department, Johns Hopkins Aramco Healthcare/Dhahran Health Center, Saudi Aramco, P.O. Box 76, Dhahran 31311, Eastern Province, Saudi Arabia.
| | - Salwa Sheikh
- Pathology Department, Johns Hopkins Aramco Healthcare/Dhahran Health Center, Saudi Aramco, P.O. Box 76, Dhahran 31311, Eastern Province, Saudi Arabia
| | - Faisal Shareefi
- Surgery Department, Johns Hopkins Aramco Healthcare/Dhahran Health Center, Saudi Aramco, P.O. Box 76, Dhahran 31311, Eastern Province, Saudi Arabia
| | - Rana Shahab
- Dermatology Department, Johns Hopkins Aramco Healthcare/Dhahran Health Center, Saudi Aramco, P.O. Box 76, Dhahran 31311, Eastern Province, Saudi Arabia
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Souaf I, Ameurtesse H, Debbagh FZ, Idrissi K, Znati K, Amarti A. [Mucinous primitive skin carcinoma: report of two cases and review of the literature]. Pan Afr Med J 2015; 18:340. [PMID: 25574316 PMCID: PMC4282812 DOI: 10.11604/pamj.2014.18.340.2970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 08/26/2014] [Indexed: 11/11/2022] Open
Abstract
Le carcinome mucineux primitif cutané est une tumeur annexielle rare, développée à partir des glandes sudoripares. Il se localise en générale à l'extrémité céphalique, surtout la région périorbitaire. Nous rapportons deux observations d'un carcinome mucineux primitif de la face et de la région axillaire, chez deux patients âgés de 60 ans. L’étude histologique montrait une prolifération tumorale dermohypodermique, faite de cellules organisées en cordons, en amas et en massif cribriformes, au sein d'une substance mucoïde. En immunohistochimie les cellules tumorales exprimaient la cytokératine 7, l'EMA et les récepteurs hormonaux. L'actine musculaire lisse a bien marqué les cellules myoépithéliales au niveau de la composante in situ dans un seul cas. Le carcinome mucineux primitif cutané est difficile à différencier d'une métastase mammaire ou digestive. La mise en évidence de carcinome in situ ou de cellules myoépithéliale est en faveur de l'origine cutanée primitive. C'est une tumeur à croissance lente, avec des métastases exceptionnelles. Le traitement est chirurgical et le taux de récidive est très élevé. Et à travers ces deux observations, les auteurs mettent en relief les principaux aspects cliniques, histologiques, thérapeutiques de cette entité avec une revue de la littérature.
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Affiliation(s)
- Ihsane Souaf
- Service d'Anatomie et de Cytologie Pathologique, CHU Hassan II, Fès, Maroc
| | | | | | - Karima Idrissi
- Service d'Anatomie et de Cytologie Pathologique, CHU Hassan II, Fès, Maroc
| | - Kawter Znati
- Service d'Anatomie et de Cytologie Pathologique, CHU Hassan II, Fès, Maroc ; Laboratoire de Recherche et Biologie de cancer, CHU Hassan II, Fès, Maroc
| | - Affaf Amarti
- Service d'Anatomie et de Cytologie Pathologique, CHU Hassan II, Fès, Maroc ; Laboratoire de Recherche et Biologie de cancer, CHU Hassan II, Fès, Maroc
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[Suspected tumor of the upper eyelid]. Ophthalmologe 2013; 110:1073-5. [PMID: 24231913 DOI: 10.1007/s00347-013-2896-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mucin-producing sweat gland carcinoma of the eyelid: diagnostic and prognostic considerations. Am J Ophthalmol 2013; 155:585-592.e2. [PMID: 23218693 DOI: 10.1016/j.ajo.2012.09.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Revised: 09/19/2012] [Accepted: 09/20/2012] [Indexed: 11/24/2022]
Abstract
PURPOSE To describe the clinical and pathologic characteristics of mucin-producing sweat gland carcinoma of the eyelid and to determine whether neuroendocrine differentiation is of prognostic significance. DESIGN Retrospective interventional case series. METHODS Search of the New York Eye and Ear Infirmary pathology database between 1990 and 2011 identified 16 patients with mucin-producing sweat gland carcinoma. Clinical, histopathologic, and immunohistochemical analyses were performed on all identified cases. RESULTS The patients presented with vascularized, focally cystic, nonulcerated eyelid margin lesions. Histopathologic evaluation showed that 4 lesions (25%) had a cystic, papillary, and solid growth pattern with an in situ component, 7 (44%) were pure invasive mucinous carcinomas, and 5 (31%) demonstrated both growth patterns. Immunohistochemical analysis of 15 tumors showed that pure cystic/papillary lesions had a significantly greater percentage of synaptophysin-immunoreactive cells (P = .036). There was no significant difference in the number of neuroendocrine markers expressed or in the intensity of immunostaining among the 3 different growth patterns. Re-excision for margin clearance was performed in 8 of 13 cases (61.5%). Two of 13 lesions recurred (15%); 1 of these was an in situ tumor with cystic morphology and neuroendocrine differentiation and the other was pure invasive mucinous carcinoma. None of the lesions metastasized. CONCLUSIONS Mucin-producing sweat gland carcinoma pathologically represents a continuum, from an in situ lesion to a classic, invasive mucinous carcinoma. Immunohistochemical evidence of neuroendocrine differentiation can be observed in all lesions and does not appear to have a prognostic significance, arguing against the utility of immunohistochemical subtyping of mucinous sweat gland carcinomas.
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Harvey DT, Taylor RS, Itani KM, Loewinger RJ. Mohs micrographic surgery of the eyelid: an overview of anatomy, pathophysiology, and reconstruction options. Dermatol Surg 2012; 39:673-97. [PMID: 23279119 DOI: 10.1111/dsu.12084] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mohs micrographic surgery (MMS) is the ideal treatment for skin cancer removal. The advantages of MMS in the eyelid area include its high cure rate, tissue-sparing effects, and overall cost effectiveness. OBJECTIVE To review eyelid anatomy, detail ocular tumors that are amenable to MMS, and examine the surgical repair options commonly used in this area. MATERIALS AND METHODS A review of the literature on MMS of the eyelid was performed with specific reference to ocular anatomy, eyelid malignancy types, and surgical reconstruction. CONCLUSION Eyelid function is critical for the maintenance of ocular health and vision. MMS is an ideal skin cancer treatment for the delicate structure of the eyelid, where maximal tissue preservation is critical. There are a plethora of reconstruction options to consider after MMS has been performed in this area. The choice of repair and surgical outcome depend, in part, on the surgeon's knowledge of eyelid anatomy and his or her ability to assess the repair requirements of the post-MMS defect. Dermatologic surgeons can effectively work with other specialists to help ensure that their patients receive a cure with restored ocular function and optimal cosmesis.
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Affiliation(s)
- David T Harvey
- Department of Dermatology, Dermatologic Surgery, University of Texas Southwestern, Dallas, Texas, USA.
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Mucinous eccrine carcinoma: a rare case of recurrence with lacrimal gland extension. Ophthalmic Plast Reconstr Surg 2012; 28:e109-10. [PMID: 22327636 DOI: 10.1097/iop.0b013e31823c80ba] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mucinous eccrine carcinoma (MEC) is a rare skin cancer of sweat gland origin with a high rate of recurrence. The most common sites are head and neck, with 40% of cancers found on the eyelid. The clinical appearance and differential diagnosis of MEC are highly varied, but histologically it is similar to metastatic carcinomas, specifically breast and colon. A diagnosis of primary MEC always warrants a full systemic workup to ensure that no other malignancy is present. This cancer is known for frequent recurrences, but rarely metastasizes to distant organs. MEC is resistant to both chemotherapy and radiation; surgical excision remains the treatment of choice in most cases. The authors report a unique case of extension of MEC to the lacrimal gland with a brief review of histologic characteristics of this tumor.
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Connolly SM, Baker DR, Coldiron BM, Fazio MJ, Storrs PA, Vidimos AT, Zalla MJ, Brewer JD, Smith Begolka W, Berger TG, Bigby M, Bolognia JL, Brodland DG, Collins S, Cronin TA, Dahl MV, Grant-Kels JM, Hanke CW, Hruza GJ, James WD, Lober CW, McBurney EI, Norton SA, Roenigk RK, Wheeland RG, Wisco OJ. AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs micrographic surgery: A report of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery. J Am Acad Dermatol 2012; 67:531-50. [DOI: 10.1016/j.jaad.2012.06.009] [Citation(s) in RCA: 224] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 06/07/2012] [Accepted: 06/12/2012] [Indexed: 10/27/2022]
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Connolly SM, Baker DR, Coldiron BM, Fazio MJ, Storrs PA, Vidimos AT, Zalla MJ, Brewer JD, Begolka WS, Berger TG, Bigby M, Bolognia JL, Brodland DG, Collins S, Cronin TA, Dahl MV, Grant-Kels JM, Hanke CW, Hruza GJ, James WD, Lober CW, McBurney EI, Norton SA, Roenigk RK, Wheeland RG, Wisco OJ. AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs micrographic surgery: a report of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery. Dermatol Surg 2012; 38:1582-603. [PMID: 22958088 DOI: 10.1111/j.1524-4725.2012.02574.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The appropriate use criteria process synthesizes evidence-based medicine, clinical practice experience, and expert judgment. The American Academy of Dermatology in collaboration with the American College of Mohs Surgery, the American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery has developed appropriate use criteria for 270 scenarios for which Mohs micrographic surgery (MMS) is frequently considered based on tumor and patient characteristics. This document reflects the rating of appropriateness of MMS for each of these clinical scenarios by a ratings panel in a process based on the appropriateness method developed by the RAND Corp (Santa Monica, CA)/University of California-Los Angeles (RAND/UCLA). At the conclusion of the rating process, consensus was reached for all 270 (100%) scenarios by the Ratings Panel, with 200 (74.07%) deemed as appropriate, 24 (8.89%) as uncertain, and 46 (17.04%) as inappropriate. For the 69 basal cell carcinoma scenarios, 53 were deemed appropriate, 6 uncertain, and 10 inappropriate. For the 143 squamous cell carcinoma scenarios, 102 were deemed appropriate, 7 uncertain, and 34 inappropriate. For the 12 lentigo maligna and melanoma in situ scenarios, 10 were deemed appropriate, 2 uncertain, and 0 inappropriate. For the 46 rare cutaneous malignancies scenarios, 35 were deemed appropriate, 9 uncertain, and 2 inappropriate. These appropriate use criteria have the potential to impact health care delivery, reimbursement policy, and physician decision making on patient selection for MMS, and aim to optimize the use of MMS for scenarios in which the expected clinical benefit is anticipated to be the greatest. In addition, recognition of those scenarios rated as uncertain facilitates an understanding of areas that would benefit from further research. Each clinical scenario identified in this document is crafted for the average patient and not the exception. Thus, the ultimate decision regarding the appropriateness of MMS should be determined by the expertise and clinical experience of the physician.
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Affiliation(s)
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- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA
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Amano M, Chosa N, Kuroiwa A, Narita Y, Mochida K, Koketsu H, Setoyama M. Primary mucinous carcinoma of the skin in the hypogastric region: a case of regional lymph node metastases 2 years after surgery. J Dermatol 2012; 39:1040-1. [PMID: 22670786 DOI: 10.1111/j.1346-8138.2012.01580.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
BACKGROUND The periocular skin is susceptible to numerous benign and malignant neoplasms. Periocular malignancies may present differently, behave more aggressively, and pose greater challenges for treatment and repair than malignancies at other cutaneous sites. Between 5% and 10% of cutaneous malignancies occur periorbitally, with basal cell carcinoma reported as the most common malignant periocular tumor, followed by squamous cell carcinoma, sebaceous gland carcinoma, cutaneous melanoma, Merkel cell carcinoma, and other rare tumors. OBJECTIVE To review the current literature on cutaneous malignancies of the periocular region pertaining to etiology, incidence, clinical presentation, differential diagnosis, complications, and treatment options. MATERIALS AND METHODS An extensive literature review was conducted using PubMed, searching for articles on periocular and periorbital cutaneous malignancies. CONCLUSIONS Timely diagnosis and management of periocular malignancies is essential because of their proximity to and potential to invade vital structures such as the orbit, sinuses, and brain. Surgical excision remains the standard of care for the majority of periorbital malignancies, but given the sensitive anatomic location, tissue-sparing techniques with margin control such as Mohs micrographic surgery are the preferred method for most nonmelanoma skin cancers. Depending on tumor type, other treatment modalities may include radiation, chemotherapy, cryosurgery, topical medications, and photodynamic therapy.
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Affiliation(s)
- Jordan B Slutsky
- Department of Dermatology, Saint Louis University, Saint Louis, Missouri 63104, USA.
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Nizawa T, Oshitari T, Kimoto R, Kajita F, Yotsukura J, Asanagi K, Baba T, Takahashi Y, Oide T, Kiyokawa T, Kishimoto T, Yamamoto S. Early-stage mucinous sweat gland adenocarcinoma of eyelid. Clin Ophthalmol 2011; 5:687-9. [PMID: 21629575 PMCID: PMC3104798 DOI: 10.2147/opth.s19855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Indexed: 11/23/2022] Open
Abstract
We present the findings of an early-stage primary mucinous sweat gland adenocarcinoma in the lower eyelid of a Japanese patient. The patient was a 73-year-old man who had had a nodule on the left lower eyelid for two years. He was referred to our hospital with a diagnosis of a swollen chalazion. The clinical and histopathological records were reviewed and the mass was excised. Histopathological examination revealed a mucinous sweat gland adenocarcinoma. Postoperative magnetic resonance imaging and positron emission tomography excluded systemic metastases. After the histopathological findings, a complete surgical excision of the margins of the adenocarcinoma was performed, with histopathological confirmation of negative margins. After the final histopathological examination, the patient was diagnosed with a primary mucinous sweat gland adenocarcinoma of the left eyelid. Six months after the surgery, no recurrence has been observed. Because the appearance of mucinous sweat gland adenocarcinoma of the eyelid is quite variable, the final diagnosis can only be made by histopathological examination. A complete surgical excision is recommended.
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Affiliation(s)
- Tomohiro Nizawa
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Japan
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Sheth RN, Placantonakis DG, Gutin PH. Intracranial and spinal metastases from eccrine mucinous carcinoma: case report. Neurosurgery 2011; 67:E861-2. [PMID: 20657314 DOI: 10.1227/01.neu.0000377860.59894.a3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Mucinous eccrine carcinoma (MEC) is a rare but distinct type of sweat gland tumor. MECs tend to recur locally, and their spread to distant organs is very uncommon. This article describes the first case of MEC metastasizing to the brain and the spine. CLINICAL PRESENTATION A 45-year-old female presented with a 2-year history of a scalp mass in the occipital area with lymph node spread. She underwent excision of the mass and neck lymph node dissection. Pathology confirmed the diagnosis of MEC. Postoperatively, she received radiation to the involved areas. Four years later the patient presented with left hemiparesis and underwent craniotomy for gross total resection of the metastasis. This recurred after 2.5 years and she underwent another craniotomy for gross total resection followed by whole brain radiation. In addition, the patient had metastases to T11 vertebral body and the left C6 to 7 neural foramen. Moreover, the patient developed leptomeningeal disease in the spine. The metastases to the spine were treated with radiation therapy. The patient died 1.5 years later. CONCLUSION Even though it is rare for MEC to spread to distant organs, physicians should be aware of the risk of metastatic invasion of the brain and spine and be vigilant about surveillance of these sites. MEC metastases to the brain should be treated aggressively with surgical resection followed by stereotactic radiosurgery to the tumor bed. Spine metastases should be treated with a combination of surgery and image-guided radiation therapy, depending on the degree of cord compression from epidural metastatic disease.
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Affiliation(s)
- Rishi N Sheth
- Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
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Segal A, Segal N, Gal A, Tumuluri K. Mucinous sweat gland adenocarcinoma of the eyelid - current knowledge of a rare tumor. Orbit 2010; 29:334-340. [PMID: 21158574 DOI: 10.3109/01676830.2010.516469] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE To review the medical literature on mucinous sweat gland adenocarcinoma of the eyelid (MSA) and present two new cases. METHODS Details of published case reports and small series (between 1971-2010) were evaluated and summarized including two patients diagnosed and treated at our institution. Data regarding age, gender, ethnicity, precise location, clinical presentation, treatment and follow up of each patient were collected. RESULTS 25 reports describing 55 patients were found in the medical literature. The mean age was 61.3 years (30-87), 22(59%) were male and 28(80%) were Caucasian. In 23(44.2%) patients the lesion was in the lower lid, in 20(38.5%) in the upper lid, in 3(5.7%) involving both lids and in 6(11.6%) in a canthus. In 12(21.8%) patients a lesion with a benign diagnosis was previously excised from the same location. In 2 of them histological re-examination resulted in a diagnosis of MSA. Intraorbital involvement was found in 2(3.6%) patients. Regional lymph node metastasis was found in 2(4.4%) patients. Surgical excision was the treatment of choice using Mohs' micrographic-controlled excision technique in recent years. Radiotherapy was applied to 2 patients with clinical resolution in 1. Recurrence of the tumor was reported in 14(30%) patients. CONCLUSIONS MSA is a rare tumor of the eyelid with no clinically distinguishing features. It should be suspected particularly with recurrent eyelid lesions and must be differentiated from metastatic disease. The tumor may extend into the orbit and metastasize regionally. Surgical removal with continued regular follow-up examination is the treatment of choice.
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Affiliation(s)
- Avichai Segal
- Oculoplastic Surgery Unit, Sydney Eye Hospital, Sydney, New South Wales, Australia.
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22
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Kampshoff JL, Cogbill TH. Unusual skin tumors: Merkel cell carcinoma, eccrine carcinoma, glomus tumors, and dermatofibrosarcoma protuberans. Surg Clin North Am 2009; 89:727-38. [PMID: 19465208 DOI: 10.1016/j.suc.2009.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This article discusses the epidemiology, etiology, presentation, pathology, evaluation and staging, and treatment of unusual skin tumors, such as Merkel cell carcinoma, eccrine carcinoma, glomus tumors, and dermatofibrosarcoma protuberans.
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Affiliation(s)
- Jesse L Kampshoff
- Department of Medical Education, Gundersen Lutheran Medical Foundation, 1900 South Avenue, C03-006A, La Crosse, WI 54601, USA
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23
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Chauhan A, Ganguly M, Takkar P, Dutta V. Primary mucinous carcinoma of eyelid: a rare clinical entity. Indian J Ophthalmol 2009; 57:150-2. [PMID: 19237793 PMCID: PMC2684428 DOI: 10.4103/0301-4738.45509] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Primary cutaneous mucinous carcinoma of the eyelid, a rare pathologic entity, is an adenocarcinoma of the eccrine glands. Though it has low metastatic potential, it does have a significant recurrence rate. We present the occurrence, clinical and histological features, and management of this tumor in a 62-year-old male who presented with a recurrent, firm, nodular left lower lid lesion. He underwent excision with a 5 mm margin and the defect was repaired with a Mustarde's cheek rotation flap. A full oncological screening, including whole-body Positron Emission Tomography scan, excluded the presence of primary mucinous carcinoma elsewhere and any metastatic spread. This case underscores the importance of considering this tumor in recalcitrant eyelid lesions and highlights the pathology of this tumor.
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Affiliation(s)
- Ashutosh Chauhan
- Department of Oncosurgery, Army Hospital (Research and Referral) , Delhi, India.
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McGuire JF, Ge NN, Dyson S. Nonmelanoma skin cancer of the head and neck I: histopathology and clinical behavior. Am J Otolaryngol 2009; 30:121-33. [PMID: 19239954 DOI: 10.1016/j.amjoto.2008.03.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 03/08/2008] [Indexed: 01/03/2023]
Abstract
Non-Melanoma skin cancer (NMSC) is the most commonly encountered malignancy in almost every area of practice, but the cases that present to an Otolaryngology practice will be advanced in nature. The major subtypes of NMSC include basal cell carcinoma, squamous cell carcinoma, dermatofibrosarcoma protuberans, merkel cell carcinoma, and adnexal malignancies. In this review, we present the epidemiology, histology, clinical presentation and management of these major subtypes. Further, we present background on multimodality treatment for NMSC lesions that have become metastatic from their primary site and an introduction to the behavior and treatment of NMSC lesions in patients who have received organ transplants. Understanding the clinical behavior of advanced NMSC is essential knowledge for a general Otolaryngologist.
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Affiliation(s)
- John F McGuire
- Department of Otolaryngology, Head and Neck Surgery, University of California, Irvine, CA 92618, USA
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Hong SM, Kim SD, Yun KJ. A Case of Primary Mucinous Adenocarcinoma on Skin of The Lateral Canthus. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2009. [DOI: 10.3341/jkos.2009.50.10.1582] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Seong Min Hong
- Department of Ophthalmology, Wonkwang University School of Medicine and Institute of Wonkwang Medical Science, Iksan, Korea
| | - Sang Duck Kim
- Department of Ophthalmology, Wonkwang University School of Medicine and Institute of Wonkwang Medical Science, Iksan, Korea
| | - Ki Jung Yun
- Department of Pathology, Wonkwang University School of Medicine and Institute of Wonkwang Medical Science, Iksan, Korea
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