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Cheung J, Rabinowitz MP, Tuluc M, Milman T. Periocular Microcystic Adnexal Carcinoma: A Case Report and a Major Review. Ophthalmic Plast Reconstr Surg 2023; 39:533-541. [PMID: 37279021 DOI: 10.1097/iop.0000000000002419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To describe a patient with periocular microcystic adnexal carcinoma (MAC) and to review the clinical presentation, systemic work-up, histopathologic features, and outcome of all previously reported periocular MAC. METHODS A major literature review. PubMed/MEDLINE and Google Scholar databases were searched for all well-documented cases of periocular MAC. RESULTS The final analysis yielded 93 patients with MAC, 48 (52%) females, 39 (42%) males, and 6 with sex not specified (6%) with an average age of 56 years (range 3 days-95 years). Most tumors were localized to the eyebrow (26/93, 28%) and lower eyelid (20/93, 22%). Of patients with known information, MAC most commonly presented as a nodule (37/68, 54%) or plaque (20/68, 29%) with poorly-defined margins (20/51, 39%) and distortion of eyelid margin (13/51, 25%). Orbital involvement at any point of the disease course was seen in 20 of 93 (22%) patients. An accurate histopathologic diagnosis on initial biopsy was made in 25 of 70 (36%) cases. Initial management included surgical excision (47/93, 51%), Mohs micrographic surgery (17/93, 18%), and excision with frozen section control of margins (8/93, 9%). Aggressive or recurrent MAC was managed with multimodal therapies, including adjuvant radiation (10/34, 29%). The average follow-up after the last treatment was 3 years (median 2, range 0.2-20 years). In total, 33 of 86 (38%) tumors recurred, and 6 of 87 (7%) metastasized. Disease-related mortality occurred in 3 of 79 (4%) of patients. CONCLUSIONS Periocular MAC is frequently misdiagnosed on initial biopsy and has a tendency for recurrence and locally aggressive behavior, highlighting the importance of accurate timely diagnosis, and appropriate management.
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Affiliation(s)
- Jesse Cheung
- Lewis Katz School of Medicine of Temple University, Philadelphia, PA, U.S.A
| | - Michael P Rabinowitz
- Oculoplastic and Orbital Surgery Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, U.S.A
| | - Madalina Tuluc
- Department of Pathology, Anatomy, and Cell Biology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, U.S.A
| | - Tatyana Milman
- Department of Pathology, Anatomy, and Cell Biology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, U.S.A
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, U.S.A
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2
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Nahm WJ, Chen S, Joseph S, Chu P, Yoo J. Neoadjuvant radiation to facilitate surgical treatment of a microcystic adnexal carcinoma with perineural invasion of the vulvar region. JAAD Case Rep 2023; 38:72-74. [PMID: 37600729 PMCID: PMC10433279 DOI: 10.1016/j.jdcr.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023] Open
Affiliation(s)
- William J. Nahm
- New York University Grossman School of Medicine, New York, New York
| | - Stanley Chen
- Massachusetts Institute of Technology, Cambridge, Massachusetts
| | | | - Paul Chu
- Bridge Dermatopathology Services, Tarrytown, New York
| | - Jane Yoo
- Mount Sinai School of Medicine, New York, New York
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3
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Saternus R, Vogt T. Maligne Adnextumoren der Haut. AKTUELLE DERMATOLOGIE 2022. [DOI: 10.1055/a-1774-9678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungNeoplasien der Hautadnexe (benigne oder maligne) können zum einen von den Talgdrüsen oder Haarfollikel ausgehen, zum andern auch eine Differenzierung Richtung ekkriner oder apokriner Schweißdrüsen zeigen. Auch Mischformen können vorkommen. Maligne Adnextumoren entstehen i. d. R. de novo. Dennoch ist auch die maligne Entartung einer vorbestehenden benignen Läsion möglich.Maligne Adnextumoren der Haut sind im Vergleich zu anderen nicht-melanozytären Hauttumoren insgesamt eine eher seltene Entität. Jedoch zeigt sich, dass die Inzidenz von malignen Adnextumoren in den letzten Jahren zugenommen hat. Ähnlich wie bei anderen Hautkrebsarten sind auch bei malignen Adnextumoren das Alter, UV-Strahlung und Immunsuppression wichtige Risikofaktoren der Tumorgenese.Da sich die Klinik sowohl von malignen als auch benignen Adnextumoren mit Ausnahme des Morbus Paget oftmals ähneln kann und wenig spezifisch ist, kommt der Histopathologie für die korrekte Diagnosestellung eine entscheidende Bedeutung zu.Gemäß der Literatur sind die häufigsten malignen Adnextumore das Talgdrüsenkarzinom (23 %), der extramammäre Morbus Paget (19 %), das Hidradenokarzinom (15 %), das Porokarzinom (7 %) sowie das mikrozystische Adnexkarzinom (MAC) (5 %). Während manche Vertreter prognostisch mit einem Basalzellkarzinom vergleichbar sind (MAC), sind andere durchaus metastasierungsfähig vergleichbar den Plattenepithelkarzinomen (Talgdrüsenkarzinom, Porokarzinom). Andere Vertreter heben sich hier prognostisch besonders negativ ab mit hoher Lokalrezidivquote und Metastasierung, z. B. das Hidradenokarzinom.Dieser Übersichtsartikel fokussiert sich auf diese 5 relativ häufigen Adnex-Malignome, die prognostisch auch die gegebene Streubreite wiedergeben und die Erfordernis einer den jeweiligen Besonderheiten geschuldeten klinischen Versorgung und Nachbetreuung unterstreichen.
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Affiliation(s)
- Roman Saternus
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, D-66421 Homburg/Saar
| | - Thomas Vogt
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, D-66421 Homburg/Saar
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4
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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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5
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Al-Wassia RK, Al-Qathmi MS. Microcystic adnexal carcinoma of the scalp treated with surgical resection along with chemoradiation: A case report and review of the literature. Saudi J Biol Sci 2021; 28:7117-7124. [PMID: 34867014 PMCID: PMC8626250 DOI: 10.1016/j.sjbs.2021.08.002] [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: 04/17/2021] [Revised: 07/31/2021] [Accepted: 08/01/2021] [Indexed: 11/29/2022] Open
Abstract
Microcystic adnexal carcinoma (MAC) is an infiltrative rare cutaneous neoplasm for which there are no consensus management guidelines because of the paucity of evidence-based practice; hence, the utility of their management is based only on previously published case reports. We report a case of a scalp lesion that was successfully treated using a combination of surgical resection, chemotherapy, and radiotherapy.
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Affiliation(s)
- Rolina K Al-Wassia
- Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Marwah S Al-Qathmi
- Department of Otolaryngology - Head and Neck Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
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6
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Quéro L, Fumagalli I, Benadon B, Mignot F, Guillerm S, Labidi M, Hennequin C. [Place of radiotherapy in the treatment of cutaneous carcinomas]. Cancer Radiother 2021; 25:593-597. [PMID: 34400089 DOI: 10.1016/j.canrad.2021.07.006] [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: 06/26/2021] [Revised: 07/03/2021] [Accepted: 07/25/2021] [Indexed: 11/24/2022]
Abstract
Basal cell carcinomas and cutaneous squamous cell carcinomas are among the most common cancerous tumors in the world. Their treatment is most often based on surgery. Adjuvant radiotherapy may be indicated in case of risk factors for recurrence or as an alternative to surgery if surgery is not feasible due to the patient's advanced age and/or co-morbidities or as an alternative to potentially mutilating surgery. Radiotherapy is also part of the therapeutic arsenal for rarer skin tumors such as Merkel cell carcinoma, cutaneous lymphomas, Kaposi's disease and cutaneous adnexal carcinomas.
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Affiliation(s)
- L Quéro
- Service de cancérologie-radiothérapie, DMU ICARE, AP-HP, Nord, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010, Paris, France; Université de Paris, Paris, France.
| | - I Fumagalli
- Service de cancérologie-radiothérapie, DMU ICARE, AP-HP, Nord, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010, Paris, France
| | - B Benadon
- Service de cancérologie-radiothérapie, DMU ICARE, AP-HP, Nord, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010, Paris, France; Université de Paris, Paris, France
| | - F Mignot
- Service de cancérologie-radiothérapie, DMU ICARE, AP-HP, Nord, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010, Paris, France; Université de Paris, Paris, France
| | - S Guillerm
- Service de cancérologie-radiothérapie, DMU ICARE, AP-HP, Nord, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010, Paris, France
| | - M Labidi
- Service de cancérologie-radiothérapie, DMU ICARE, AP-HP, Nord, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010, Paris, France
| | - C Hennequin
- Service de cancérologie-radiothérapie, DMU ICARE, AP-HP, Nord, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010, Paris, France; Université de Paris, Paris, France
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7
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Behbahani S, Yeh CJ, Pinto JO, Wassef D, Povolotskiy R, Joseph N, Lambert WC, Schwartz RA. Microcystic adnexal carcinoma of the head and neck: Characteristics, treatment, and survival statistics. Dermatol Ther 2020; 34:e14559. [PMID: 33210380 DOI: 10.1111/dth.14559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/14/2020] [Accepted: 11/11/2020] [Indexed: 11/29/2022]
Abstract
Studies on microcystic adnexal carcinoma (MAC) survival rates have been limited. This effort examines the association of patient demographics, treatment modalities, and tumor stage with overall survival (OS) in patients with MAC of the head and neck. All cases of MAC with primary sites of the skin of the head and neck, confirmed histologically, and diagnosed from 2004 to 2016 in the National Cancer Database, were analyzed. We utilized Kaplan-Meier and Cox proportional-hazard models to analyze the characteristics and survival outcomes of the 415 cases that met the criteria. The mean age of diagnosis was 63.8 years (SD ±15.8). Mean OS was 10.8 years with 5- and 10-year OS being 81.0% and 68.0%, respectively. Women were more frequently affected (59.0%; P < .001). Stand-alone primary site surgery was the most common treatment (81.4%): 15.9% of patients were treated with postexcision radiation therapy (RT). 18.3% were treated with RT with or without surgery and/or chemotherapy. RT was independently associated with a decreased hazard of death (HR = 0.23; P = .044). MAC of the head and neck disproportionately affects whites, is more common in women, and has the potential to metastasize. Surgical excision is the commonest treatment; our study shows benefit from judicious RT.
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Affiliation(s)
- Sara Behbahani
- Dermatology and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Christopher J Yeh
- Dermatology and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jessica O Pinto
- Dermatology and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - David Wassef
- Dermatology and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Roman Povolotskiy
- Dermatology and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Nia Joseph
- Dermatology and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - W Clark Lambert
- Dermatology and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Robert A Schwartz
- Dermatology and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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8
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Hinther K, Henni J, Asiniwasis RN. An atypical presentation of extensive centrofacial microcystic adnexal carcinoma responding to radiation: A case report and review of the literature. SAGE Open Med Case Rep 2020; 8:2050313X20953114. [PMID: 33062278 PMCID: PMC7534061 DOI: 10.1177/2050313x20953114] [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] [Indexed: 11/15/2022] Open
Abstract
Microcystic adnexal carcinoma is a rare cutaneous neoplasm believed to arise from pluripotent keratinocytes capable of adnexal differentiation. Due to its insidious growth and appearance, diagnosis is often delayed. A deep incisional or excisional biopsy for histopathology is the gold standard for diagnosis. Different treatment modalities have been described in the literature, including the Mohs micrographic surgery, standard excision, radiation, chemotherapy, and observation. Currently, Mohs remains the treatment of choice. We present a unique case of a 12-month history of an extensive progressive centrofacial cutaneous induration diagnosed as microcystic adnexal carcinoma in an 83-year-old female. Due to the extensive nature of the tumor, she received radiation therapy and continues to receive ongoing assessment with no evidence of clinical recurrence at 2-year post-treatment including negative scouting biopsies. To date, there is no consensus on the optimal treatment for microcystic adnexal carcinoma.
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Affiliation(s)
- Kelsey Hinther
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Jihane Henni
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
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9
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Kim DW, Lee G, Lam MB, Harris EJ, Lam AC, Thomas T, Chau NG, Tishler RB. Microcystic Adnexal Carcinoma of the Face Treated With Definitive Chemoradiation: A Case Report and Review of the Literature. Adv Radiat Oncol 2019; 5:301-310. [PMID: 32280832 PMCID: PMC7136639 DOI: 10.1016/j.adro.2019.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/29/2019] [Accepted: 11/14/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Daniel W Kim
- Department of Radiation Oncology Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Grace Lee
- Department of Radiation Oncology Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Miranda B Lam
- Department of Radiation Oncology Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Ethan J Harris
- University of Illinois College of Medicine, Chicago, Illinois
| | - Allen C Lam
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Tom Thomas
- Head and Neck Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts.,Head and Neck Reconstructive Surgery and Transoral Robotic Surgery, Atlantic Center for Head and Neck Surgery, Carol G. Simon Cancer Center, Morristown, New Jersey
| | - Nicole G Chau
- Harvard Medical School, Boston, Massachusetts.,Head and Neck Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Roy B Tishler
- Department of Radiation Oncology Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Head and Neck Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
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10
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Mamic M, Manojlovic L, Suton P, Luksic I. Microcystic adnexal carcinoma—diagnostic criteria and therapeutic methods: case report and review of the literature. Int J Oral Maxillofac Surg 2018; 47:1258-1262. [DOI: 10.1016/j.ijom.2018.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 01/15/2018] [Accepted: 03/08/2018] [Indexed: 12/22/2022]
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Aslam A. Microcystic Adnexal Carcinoma and a Summary of Other Rare Malignant Adnexal Tumours. Curr Treat Options Oncol 2018; 18:49. [PMID: 28681209 DOI: 10.1007/s11864-017-0491-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OPINION STATEMENT Microcystic adnexal carcinoma (MAC) is a rare, slow-growing, infiltrative malignant tumour most commonly found on the head and neck. It often presents as a solitary skin-coloured or yellow papule, plaque or nodule. Ultraviolet radiation, immunosuppression and ionising radiation are possible risk factors. Clinical and histological differential diagnoses include morpheaform basal cell carcinoma and desmoplastic trichoepithelioma. The diagnosis is usually made by skin biopsy, and the characteristic features are small keratin-filled cysts with nests and cords which resemble ductal structures. Immunohistochemistry can assist in differentiating MAC from other tumours. The local aggressive nature of the tumour and its potential to infiltrate beyond the assessed clinical margins warrant complete excision with marginal control, and we recommend Mohs micrographic surgery. Wide local excision is widely performed but is associated with recurrence given its infiltrative nature and extensive subclinical extension. The role of radiotherapy in the management of MAC is unclear.
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Affiliation(s)
- Arif Aslam
- St Helens and Knowsley Teaching Hospitals NHS Trust, Marshalls Cross Road, St Helens, WA9 3DA, UK.
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12
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13
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Treatment of Malignant Cutaneous Adnexal Neoplasms. ACTAS DERMO-SIFILIOGRAFICAS 2017; 109:6-23. [PMID: 28988763 DOI: 10.1016/j.ad.2017.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 12/16/2016] [Accepted: 04/15/2017] [Indexed: 12/25/2022] Open
Abstract
Malignant cutaneous adnexal neoplasms form a group of rare, typically low-grade-malignancy carcinomas with follicular, sebaceous, apocrine, or eccrine differentiation or a combination of the first 3 subtypes. Their clinical presentation is usually unremarkable, and biopsy is required to establish the differentiation subtype and the definitive diagnosis. Due to their rarity, no clear consensus has been reached on which treatment is most effective. Mohs micrographic surgery is considered to be the best option to prevent recurrence in the majority of patients. Radiotherapy and chemotherapy have been studied in very few cases and have rarely been shown to be effective.
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14
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Surgery and Adjuvant Radiation for High-risk Skin Adnexal Carcinoma of the Head and Neck. Am J Clin Oncol 2017; 40:429-432. [PMID: 25599317 DOI: 10.1097/coc.0000000000000178] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Skin adnexal carcinoma (SAC) is a rare cutaneous malignancy that arises from sebaceous and sweat glands. These carcinomas are believed to behave more aggressively than cutaneous squamous cell carcinomas (SCC) with a propensity for local recurrence. The role of adjuvant radiotherapy in SAC is undefined. METHODS We retrospectively reviewed all cases of head and neck SAC treated with surgery and adjuvant radiation from 2000 to 2012 at a single institution. RESULTS Nine cases were identified. Median age was 67 (range, 52 to 88) years. The histologies were: adnexal carcinoma (n=1), adnexal carcinoma with sebaceous differentiation (n=1), adnexal carcinoma with squamous differentiation (n=1), skin appendage carcinoma (n=1), sclerosing sweat duct carcinoma (n=1), mucinous carcinoma (n=1), ductal eccrine adenocarcinoma (n=1), porocarcinoma (n=1), and trichilemmal carcinoma (n=1). All tumors were reviewed by a dermatopathologist to confirm the SAC diagnosis.All patients had undergone surgery. Indications for adjuvant radiation included involved lymph nodes (n=4), perineural invasion (n=2), nodal extracapsular extension (n=2), positive margin (n=1), high-grade histology (n=6), multifocal disease (n=2), and/or recurrent disease (n=5). Radiation was delivered to the primary site alone (n=3), to the draining lymphatics alone (n=2), or to both (n=4). One patient received concurrent cisplatin. Median dose to the primary site was 60 Gy and to the neck was 50 Gy.Median follow-up was 4.0 years (range, 0.6 to 11.4 y). Locoregional control was 100%. Five-year progression-free survival was 89%. There was 1 acute grade 3 toxicity and no greater than or equal to grade 2 late toxicities were recorded. CONCLUSIONS Surgery and adjuvant radiation for high-risk SAC offers excellent locoregional control with acceptable toxicity.
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Waqas O, Faisal M, Haider I, Amjad A, Jamshed A, Hussain R. Retrospective study of rare cutaneous malignant adnexal tumors of the head and neck in a tertiary care cancer hospital: a case series. J Med Case Rep 2017; 11:67. [PMID: 28284233 PMCID: PMC5346454 DOI: 10.1186/s13256-017-1212-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 01/16/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Adnexal tumors of the skin are a large and diverse group of benign and malignant neoplasms, which exhibit morphological differentiation toward one of the different types of adnexal epithelium present in normal skin and they pose a diagnostic challenge. The purpose of this study is to share our experience with these rare but aggressive tumors at a tertiary care cancer hospital in a developing country. A retrospective review of 11 patients diagnosed with rare adnexal tumors and their variants from January 2005 to December 2014, treated either surgically or non-surgically, was performed to describe the clinicopathological characteristics and outcome of the disease. CASE PRESENTATION A total of 11 patients were diagnosed with adnexal carcinoma and its variants: a 34-year-old Sindhi man, a 59-year-old Punjabi woman, a 32-year-old woman from Khyber Pakhtunkhwa, a 43-year-old Punjabi woman, a 64-year-old Punjabi man, a 51-year-old man from Khyber Pakhtunkhwa, a 51-year-old Punjabi woman, a 74-year-old Punjabi woman, a 75-year-old Punjabi man, a 61-year-old man from Khyber Pakhtunkhwa, and a 53-year-old man from Khyber Pakhtunkhwa. The male to female ratio was 1.2:1. The histological variations were sebaceous differentiation (n = 4), microcystic adnexal carcinoma (n = 4), trichilemmal carcinoma (n = 1), pilomatrix carcinoma (n = 1), and hidradenocarcinoma (n = 1). The mean age at presentation was 54 years (range 32 to 75). The primary subsite of involvement was the scalp in nine patients followed by eyelids in two patients. Surgery was the primary treatment modality in almost all patients; postoperative radiotherapy (PORT) was offered to eight patients. The median dose of radiation was 45 Gy to the primary site. Indications for radiotherapy included close margins (n = 2), positive margins (n = 1), high grade histology (n = 4), and multifocal disease (n = 1). On follow-up, two patients presented with local, one regional and two patients developed distant metastasis. CONCLUSIONS Adnexal carcinomas are rare tumors with diverse histological patterns and a tendency for locoregional and distant metastasis. Surgery should be the mainstay of treatment reserving radiotherapy for adjuvant, palliative, and re-treatment scenarios.
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Affiliation(s)
- Omer Waqas
- Department of Pathology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Muhammad Faisal
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, 7-A, Block-R3, Johar Town, Lahore, Pakistan.
| | - Irfan Haider
- Department of Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Awais Amjad
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, 7-A, Block-R3, Johar Town, Lahore, Pakistan
| | - Arif Jamshed
- Department of Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Raza Hussain
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, 7-A, Block-R3, Johar Town, Lahore, Pakistan
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16
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Chen J, Yang S, Chen J, Liao T, Deng W, Li W. Microcystic adnexal carcinoma in a non-Caucasian patient: A case report and review of the literature. Oncol Lett 2016; 11:2471-2474. [PMID: 27073500 DOI: 10.3892/ol.2016.4242] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 01/11/2016] [Indexed: 11/05/2022] Open
Abstract
Microcystic adnexal carcinoma (MAC) is extremely rare among Asians, with the majority of cases presenting in Caucasian individuals. The current study describes the case of a 38-year-old Chinese woman who presented with a 10 year history of a mass in the upper lip. A biopsy resulted in a diagnosis of MAC. The patient underwent complete surgical resection and the tumor was successfully excised. During 6 months of follow-up, there was no evidence of recurrence. To the best of our knowledge, the present case is the first Chinese case to be reported in the English literature, and is presented with the aim of increasing the awareness and aiding in the management of MAC in non-Caucasian populations.
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Affiliation(s)
- Jingxin Chen
- Department of Oral and Maxillofacial Surgery, Hainan Province People's Hospital, Haikou, Hainan 570311, P.R. China; Department of Oral and Maxillofacial Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Shiping Yang
- Department of Radiation Oncology, Hainan Province People's Hospital, Haikou, Hainan 570311, P.R. China
| | - Jimin Chen
- Department of Pathology, Hainan Province People's Hospital, Haikou, Hainan 570311, P.R. China
| | - Tianan Liao
- Department of Oral and Maxillofacial Surgery, Hainan Province People's Hospital, Haikou, Hainan 570311, P.R. China
| | - Wei Deng
- Department of Oral and Maxillofacial Surgery, Hainan Province People's Hospital, Haikou, Hainan 570311, P.R. China
| | - Weizhong Li
- Department of Oral and Maxillofacial Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
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Chaudhari SP, Mortazie MB, Blattner CM, Garelik J, Wolff M, Daulat J, Chaudhari PJ. Treatments for microcystic adnexal carcinoma--A review. J DERMATOL TREAT 2015; 27:278-84. [PMID: 26331917 DOI: 10.3109/09546634.2015.1089351] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Microcystic adnexal carcinoma (MAC) is a rare malignant cutaneous neoplasm presenting as a slow-growing, indurated nodule, papule or plaque. Clinically, the lesion can blend into the surrounding skin, obscuring borders and consequently delaying diagnosis histologically. Surgical and histologic techniques that emphasize examination of all margins may optimize management through early diagnosis and prevention of recurrences. OBJECTIVE This review aims to assess the current surgical and histology techniques that result in lower rates of tumor recurrence and, consequently, better clinical outcomes. METHODS A literature search of the PubMed database was conducted to identify studies examining wide local excision (WLE), Mohs micrographic surgery (MMS), radiotherapy (RT) and chemotherapy in the treatment of MAC. RESULTS WLE had a high likelihood of positive margins and local recurrence. MMS was found to have the lowest recurrence rates. Definitive RT could be considered for elderly patients or those who are poor surgical candidates, as large surgical defects may be required to obtain free margins with either WLE or MMS. Chemotherapy was found to be ineffective. CONCLUSION Complete margin evaluation with MMS permits complete tumor removal with subsequently low recurrence rate.
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Affiliation(s)
| | - Michael B Mortazie
- b Department of Dermatology , St. Joseph Mercy Hospital , Ann Arbor , MI , USA
| | | | - Jessica Garelik
- d Department of Dermatology , Albert Einstein College of Medicine , Bronx , NY , USA
| | - Marisa Wolff
- e Department of Dermatology , St. Barnabas Hospital , Bronx , NY , USA
| | - Jaldeep Daulat
- f Las Vegas Skin & Cancer Clinics , Las Vegas , NV , USA .,g Mohave Centers for Dermatology & Plastic Surgery , Kingman , AZ , USA , and
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Microcystic adnexal carcinoma: reconstruction of a large centrofacial defect. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2014; 2:e254. [PMID: 25506537 PMCID: PMC4255897 DOI: 10.1097/gox.0000000000000195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 08/13/2014] [Indexed: 02/06/2023]
Abstract
Summary: We report a rare case of a large facial microcystic adnexal carcinoma in an elderly patient who underwent several rounds of excision. The patient was left with a large facial defect and remaining positive margins. The decision was made to stop further excision and proceed with reconstructive surgery. We show that the patient’s function and quality of life were not impeded despite reconstruction in light of positive margins for tumor. We believe that this case will draw the surgeon’s attention to the possibility of palliative reconstruction in the treatment of a patient with large debilitating facial defects after microcystic adnexal carcinoma excision.
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Green M, Mitchum M, Marquart J, Bowden LP, Bingham J. Microcystic adnexal carcinoma in the axilla of an 18-year-old woman. Pediatr Dermatol 2014; 31:e145-8. [PMID: 25424223 DOI: 10.1111/pde.12430] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Microcystic adnexal carcinoma (MAC) is an uncommon adnexal neoplasm with a predilection for the head and neck. The tumor rarely metastasizes but is locally aggressive and commonly demonstrates perineural invasion. MAC occurs most often in older adults. This report describes a young woman with a MAC in her left axilla who required two stages of Mohs micrographic surgery followed by a wide local excision because of persistent perineural invasion in close proximity to the brachial plexus. Other cases presenting in the pediatric age group are discussed.
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Affiliation(s)
- Margaret Green
- Dermatology Department, Walter Reed National Military Medical Center, Bethesda, Maryland
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Skin adnexal carcinoma of the head and neck: a retrospective study in a tertiary referral center. Eur Arch Otorhinolaryngol 2014; 272:1001-1010. [DOI: 10.1007/s00405-014-3324-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 10/06/2014] [Indexed: 11/28/2022]
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Kim LHC, Teston L, Sasani S, Henderson C. Microcystic adnexal carcinoma: successful management of a large scalp lesion. J Plast Surg Hand Surg 2013; 48:158-60. [PMID: 23968368 DOI: 10.3109/2000656x.2013.777218] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Microcystic adnexal carcinoma (MAC) is a rare, malignant cutaneous neoplasm. It is important for us to become more aware of it, as it is often misdiagnosed, either clinically or histopathologically. We report a case of an extensive scalp lesion that was successfully treated using a combination of resection and adjuvant radiotherapy.
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Affiliation(s)
- Lawrence H C Kim
- Department of Plastic and Reconstructive Surgery, Bankstown Hospital , New South Wales
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