Microcystic Adnexal Carcinoma Treated by Microscopically Controlled Excision

Abstract

Microcystic adnexal carcinoma is a distinct clinicopathologic entity with combined pilar and eccrine differentiation. Clinically it resembles other adnexal neoplasms, but it tends to be deeply invasive and locally aggressive. A 47-year-old man with microcystic adnexal carcinoma of the left cheek with deep dermal and subcutaneous invasion was successfully treated by microscopically controlled excision. The possible etiologic association with teenage radiation therapy is discussed.

Microcystic Adnexal Carcinoma of the Scalp

“…History of radiotherapy for acne prior to the development of MAC has been reported in only two cases by Cooper and Mills 7 and Fleischmann et al 8 Therefore, radiotherapy does not appear to be a significant predisposing factor in the development of MAC.…”

“…Treatment has included local wide excision, radiation alone, 10 excision followed by radiation, 1 and Mohs surgery 6–8 . Of 15 patients reported by Cooper et al, 2 9 (60%) had one or more recurrences after initial surgical excision.…”

“…Two of the 6 patients (33%) reported by Goldstein et al 1 had recurrences after treatment. Three cases described in the literature were treated with Mohs surgery 6–8 with one case having a recurrence 2 years after treatment 7 . Of the remaining cases that were reviewed, there is insufficient data regarding recurrences.…”

Microcystic Adnexal Carcinoma

“…The female predominance that was evident in our study has been observed, albeit inconsistently, in other series. 14,[18][19][20]23,24 Again, women also appeared to be affected at an older age than men. This age-sex interaction seems to be common among other adnexal neoplasms, especially syringomas and trichoblastomas.…”

Microcystic Adnexal Carcinoma with Mandibular Invasion and Bone Marrow Replacement

“…These recurrences might be secondary to an initial lack of recognition of the tendency for aggressive peripheral and deep invasion by these tumors, resulting in inadequate surgical excision or radiation treatment. Mohs micrographically controlled surgery offers several advantages for treatment of these tumors, as has been reported previously 3 …”