Primary cutaneous adenoid cystic carcinoma treated with Mohs micrographic surgery toluidine blue technique

A patient with primary cutaneous adenoid cystic carcinoma treated with Mohs surgery is presented. This tumor is characterized clinically by frequent local recurrences and infrequent metastases. Histologically it demonstrates cribiform islands of tumor cells with an abundance of mucin. Because toluidine blue stains this mucin metachromatically, it may be superior to hematoxylin and eosin for identifying the presence of this tumor. We recommend Mohs micrographic surgery with toluidine blue staining technique for the treatment of adenoid cystic carcinoma.