Microcystic adnexal carcinoma: Collaborative series review and update,☆☆,

Presented at the 31st Annual Meeting of the American College of Mohs Micrographic Surgery and Cutaneous Oncology, Miami, Fla, May 18, 1999.
https://doi.org/10.1016/S0190-9622(99)70053-8Get rights and content

Abstract

Background: Microcystic adnexal carcinoma (MAC) is a malignant appendageal tumor first described in 1982. It can be clinically and histologically confused with other malignant and benign cutaneous neoplasms, leading to inadequate initial treatment. This neoplasm is locally aggressive and deeply infiltrating, characterized by high morbidity and frequent recurrence. Mohs micrographic surgery has been used to conserve tissue and improve the likelihood for cure. Objective: We report our experience using Mohs micrographic surgery for the treatment of MAC and compare with earlier reports in the literature. In addition, we review the epidemiology, clinical and histologic characteristics, and optimal treatment of this rare neoplasm. We also describe a 15-year-old white male patient with MAC on the scalp occurring only 7 years after radiation exposure. Methods: The medical records of 11 patients with MAC who were treated by Mohs micrographic surgery were reviewed at both departments, and follow-up data were obtained. Results: In all patients treated with Mohs micrographic surgery, there were no recurrences after a mean follow-up of 5 years. Conclusion: Mohs technique enables the detection of clinically unrecognizable tumor spread and perineural invasion often encountered with MAC. Aggressive initial treatment by microscopically controlled excision appears to offer the greatest likelihood of cure for this neoplasm, while providing conservation of normal tissue. In addition, we describe the second youngest patient with MAC and readdress the issue of previous radiotherapy as an important predisposing factor. (J Am Acad Dermatol 1999;41:225-31.)

Section snippets

MATERIAL AND METHODS

The medical records of 11 patients with MAC treated at the New York University Medical Center (P. R.) and the University of Tennessee Medical Center (R. A.) by Mohs micrographic surgery between 1986 and 1997 were reviewed. In each case, histologic diagnosis was confirmed by a dermatopathologist on the basis of sectioned, paraffin-embedded biopsy specimens stained with hematoxylin and eosin.

Mohs surgical excisions were performed and followed by sectioning and mapping of the tissue layer. After

RESULTS

The overall age of the patients ranged from 15 to 83 years (median, 63; mean, 62 years). The female-to-male ratio was 3.5:2. Tumors were located primarily on the head and neck area. Two of the patients experienced MAC at sites of previous radiotherapy. Of the 11 patients, 9 had primary tumor, and 2 presented with recurrence of MAC after primary excision. Tissue sections of all patients demonstrated tumor spreading several centimeters laterally beyond clinically apparent tumor tissue. The

DISCUSSION

MAC occurs predominantly on the head and neck, particularly in the centrofacial region. Involvement of the ear has been reported only twice previously,2, 3 and there are 3 cases of scalp involvement in the literature.4, 5, 6 Of the 105 cases reported in the English language literature (including our 11 cases), the median age of presentation was 56 years. Of these cases, the sex distribution was approximately equal, 54 (51%) occurring in men and 51 (49%) occurring in women. This neoplasm occurs

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    From the Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York,a and the Division of Dermatology, University of Tennessee Medical Center, Memphis.b

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