Mohs Micrographic Surgery, Sentinel Lymph Node Mapping, and Estrogen Receptor Analysis for the Treatment of Malignant Nodular Hidradenoma

Prognostic analysis of hidradenocarcinoma: a SEER-based observational study

BACKGROUND

Hidradenocarcinoma is a rare malignancy of sweat gland differentiation. Published literature has reported that hidradenocarcinoma has a high recurrence and metastasis rate, and the prognosis is extremely poor. However, the sample sizes included in these studies are insufficient, and therefore, the findings are doubtful.

MATERIALS AND METHODS

Clinicopathological characteristics and survival data of 289 hidradenocarcinoma patients were extracted from the SEER database (covering 18 registries, 2000-2018) released in July 2021. The distribution of clinicopathological characteristics was compared using the Pearson chi-square test. Overall survival (OS) and cancer-specific survival (CSS) were analysed using the log-rank test and univariate analysis.

RESULTS

The primary site of hidradenocarcinoma in 121 patients was located in the head and neck, accounting for 41.9%, and the others were located in the trunk and limbs. For hidradenocarcinoma, the mean OS and CSS were 164 months and 165.9 months, respectively; the 10-year OS rate and CSS rate were 60.2% and 90.5%, respectively. Survival analysis showed that the primary site, sex, age, race, histologic grade, stage, and surgery are not associated with hidradenocarcinoma patients' OS or CSS. For head and neck hidradenocarcinoma or trunk and limbs hidradenocarcinoma, sex, age, race, histologic grade, AJCC stage, and primary site surgery are still not related to prognosis. Tumour size is correlated with patients' OS rather than CSS.

CONCLUSIONS

Hidradenocarcinoma is a malignant tumour with a good prognosis, which is different from previous views. Tumour size is inversely proportional to patients' overall survival time affecting the OS and CSS of patients. Improving health awareness, initial histological examination and timely surgery are the keys to improving the prognosis.

Malignant Nodular Hidradenoma of the Left Knee: A Malignant Mystery With an Overview of Literature

Malignant nodular hidradenoma is a rare eccrine sweat gland neoplasm characterized by recurrence, metastasis, and a locally aggressive course. In our case report, a 74-year-old man presented with a seemingly benign swelling which was persistent for the last 30 years, which was excised at an outside institute. Since the patient presented to the hospital during the peak of the pandemic, considering the age of the patient, the pandemic situation, the logistics of radiotherapy during such a situation, preserving the knee joint function in view of close proximity of the tumour to the joint, it was decided to keep the patient on follow up and continue expectant management. After a follow-up period of 24 months, no locoregional recurrence or metastasis has been observed. The patient is on annual follow-up with clinical examination and PET-CECT imaging.

Malignant nodular hidradenoma of the skin: report of seven cases

BACKGROUND

Malignant nodular hidradenoma (MNH) is an infrequent, highly malignant, primary skin tumour derived from eccrine sweat glands. Most tumours occur in elderly individuals. MNH has very poor prognosis, high recurrence and a high rate of metastases. The best method of treatment is still unclear: radical surgical excision is widely used, and selective lymph node dissection is also suggested. The value of the adjuvant radiotherapy and chemotherapy has not been confirmed.

PATIENTS AND TREATMENT

Seven MNH patients (4 men, 3 women, age 60-87 years) were treated between 1991 and 2007 in the Dermatology Unit of San Donato Hospital of Arezzo and in the Section of Dermatology of University of Siena, Italy. Tumours varied from 0.8 to 4.4 cm in size. All patients underwent local excision; five also had lymph node dissection. One patient underwent adjuvant radiotherapy, and three received chemotherapy.

RESULTS

Six of seven patients died, with survival varying from 15 to 45 months. Distant metastases occurred in two patients. Survival time was inversely proportional to the size of the tumour.

CONCLUSIONS

MNH is an aggressive tumour and should be diagnosed and excised as early as possible. Histological parameters are paramount, but correct diagnosis also calls for attention to clinical presentation and any history of recurrence or recent enlargement of long-standing lesions. In our experience, radiotherapy and chemotherapy do not seem to prolong survival.