Eyelid Microcystic Adnexal Carcinoma

Background: Microcystic adnexal carcinoma, or sclerosing sweat duct carcinoma, is an uncommon cutaneous neoplasm associated with extensive local invasion. The standard of care with regard to the best excisional method in treating microcystic adnexal carcinoma has not been established.Objectives: To perform a retrospective study comparing patients treated by Mohs micrographic surgery with those treated by wide excision and to elucidate the epidemiological features of microcystic adnexal carcinoma. Patients and Methods:A retrospective analysis of a case series involving 48 primary and referral patients diagnosed as having microcystic adnexal carcinoma using standardized criteria. All cases were reviewed by the same dermatopathologists.Results: Microcystic adnexal carcinoma predominantly affects the left side of the face of middle-aged women. Microcystic adnexal carcinoma is misdiag-

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“…3,4,29 We demonstrated a median 4-fold in- †A lesion within this group recurred during the study period.…”

Section: Commentmentioning

confidence: 70%

Microcystic Adnexal Carcinoma

Chiller

Passaro²,

Scheuller³

et al. 2000

Arch Dermatol

165

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“…MAC has also been referred to as malignant syringoma, sweat gland carcinoma with syringomatous features, and sclerosing sweat duct carcinoma. 4,11,25,26 Because MAC almost always occurs in the head and neck region 1-5,7-10,27 exposure to solar or x-ray radiation may be of etiologic significance. 1,3,5,18,23,28 In several cases the patients had previously received radiotherapy for adolescent acne or cancers.…”

Section: Discussionmentioning

confidence: 99%

“…3,5,7,10 As a result, the time from the first recognition of the skin lesion to the diagnosis of MAC can range from 6 months to 30 years. 3,9,[11][12][13] Clinically, MAC appears as an indurated, yellowish colored plaque. In most cases, overlying telangiectasias are present.…”

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confidence: 99%

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Microcystic Adnexal Carcinoma: An Often Misdiagnosed, Locally Aggressive Growing Skin Tumor

Fischer

Breuninger²,

Metzler³

et al. 2005

Journal of Craniofacial Surgery

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Microcystic adnexal carcinoma (MAC) belongs to the spectrum of locally aggressive adnexal carcinomas and most commonly occurs in the head and neck region. Recently it has been proposed that MAC is an apocrine tumor. It is characterized by slow, but locally aggressive growth with infiltration of subcutaneous fat tissue, muscles, perichondrium, periosteum, or perineurium. As a result, surgical treatment often leads to ablation defects, which are many times the size of the clinical lesion. In 1982, Goldstein and colleagues first reported MAC to be a distinct histologic entity characterized by a combination of keratinous cysts in the upper dermis, islands and strands of small basaloid, benign-appearing keratinocytes or squamous cells in the deeper dermis within a dense desmoplastic stroma, and areas of ductular differentiation. The authors report the case of a 78-year-old woman in whom a diagnosis of MAC was made when a tumor on the right cheek recurred for the second time. Previous histopathologic diagnoses were squamous cell carcinoma and desmoplastic trichoepithelioma. Local recurrences of the tumor occurred, despite histographic surgery because in hematoxylin and eosin stains, small islands of the deceptively benign-appearing small basaloid cells of MAC were not recognized as tumor cells. The reported case demonstrates the difficulties in diagnosing MAC and indicates that MAC should always be considered in the differential diagnosis of slowly growing tumors in the head and neck region. If MAC is diagnosed too late, it can be inoperable because of its infiltrative growth.

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“…220,221 Neoplastic cells may infiltrate blood vessels, skeletal muscle and perineural spaces. 153,[222][223][224][225][226][227][228] Concentric whorls of tumor cells and clear cell change are described. 229 Inspisated secretory material and an internal lining cuticle expressing CEA (Figure 20) give evidence to eccrine differentiation in these neoplasms.…”

Section: Histopathologymentioning

confidence: 99%

Malignant adnexal neoplasms

2006

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Malignant cutaneous adnexal neoplasms are one of the most challenging areas of dermatopathology. Tumors of the pilosebaceous apparatus can occur as single-lineage neoplasms or may manifest as complex proliferations with multilineal differentiation patterns including not only the germinative component of the hair bulb, the inner or outer root sheath epithelium and the sebaceous gland and duct, but also the sweat duct components that relate to the apocrine secretory apparatus which empties into the follicle near the follicular bulge. Eccrine and apocrine neoplasms present a bewildering array of morphologies, which often defy precise classification. The purpose of this review is to discuss in detail the malignant neoplasms of the cutaneous adnexae and their benign and prognostically indeterminate mimics. Modern Pathology (2006) 19, S93-S126. doi:10.1038/modpathol.3800511Keywords: eccrine carcinoma; sebaceous neoplasia Malignant tumors of the pilosebaceous apparatus, their mimics and precursors IntroductionTumors of the pilosebaceous unit can occur in isolation or in combination with complex proliferations showing multilineal differentiation patterns encompassing those of sweat ducts, epidermis and stroma with its varied components. In this review, we will focus upon the malignant adnexal proliferations, considering benign entities mainly insofar as they impact the diagnostic approach to adnexal carcinoma. We will first turn to the malignant sebaceous neoplasms, their precursors and their mimics. Sebaceous adenoma Clinical FeaturesThe sebaceous adenoma is a benign neoplasm that manifests clinically as a pale yellow nodular lesion, typically of the face, that expresses itself clinically after the age of 50. Tumors range in size from o1 to 45 cm. [1][2][3][4][5][6] These lesions are associated with the Muir-Torre syndrome, comprising the coexpression of cutaneous neoplasms, including those of sebaceous type with well-differentiated squamous epithelial neoplasms, and visceral malignancies, including carcinomas of the breast, ovary, gastrointestinal tract and larynx. [7][8][9][10][11][12][13][14] An occasional patient may manifest a malignant lymphoma of nodal or extranodal type. 10,12,14 Sebaceous neoplasms in the setting of Muir-Torre syndrome are often difficult to classify, showing overlap features between all of the prototypic forms of sebaceous neoplasm ranging from hyperplasia to carcinoma. 13 HistologyThe prototypic sebaceous adenoma manifests 1-2 layers of germinitive cells which mature to form central sebocytes, and have an architecture comprising a sharply circumscribed sebaceous lobule surrounded by a compressed pseudocapsule of dermal stroma ( Figure 1a). The overlying epidermis may be attenuated, but sometimes forms a collarette around the peripheral aspect of the neoplasm. Unlike sebaceous hyperplasia, occasional mitoses may be seen in the lobules of a sebaceous adenoma and in concert with this nucleoli may be somewhat prominent, but the pleomorphism, hyperchromasia and individual cell necrosis of the se...

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Eyelid Microcystic Adnexal Carcinoma

Cited by 8 publications

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Microcystic Adnexal Carcinoma

Microcystic Adnexal Carcinoma

Microcystic Adnexal Carcinoma: An Often Misdiagnosed, Locally Aggressive Growing Skin Tumor

Malignant adnexal neoplasms

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