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Adnexal Carcinomas Treated With Mohs Micrographic Surgery: A Comprehensive Review
1Surgical Dermatology Group, Birmingham, Alabama.
Background:
Adnexal carcinomas (ACs) are rare cutaneous malignancies of sweat gland or pilosebaceous origin. Optimal treatment and metastatic potential of AC are poorly defined. Mohs micrographic surgery (MMS) has been increasingly used to treat AC.
Objective:
To review selected primary cutaneous AC and their treatment outcomes with MMS.
Materials And Methods:
Literature review using PubMed search for articles related to primary cutaneous ACs.
Results:
Sebaceous carcinoma treated with MMS recurred and metastasized in 6.4% and 3.7%, respectively. Primary cutaneous mucinous carcinoma treated with MMS recurred and metastasized in 9.6% and 6.4%, respectively. After MMS, 4.7% of microcystic AC recurred with no reported metastases. After MMS, recurrences and metastases of trichilemmal carcinoma or hidradenocarcinoma have not been reported. Two (4.2%) regional lymph node metastases but no distant metastases or local recurrences have been reported in eccrine porocarcinoma. Squamoid eccrine duct tumor, pilomatrix carcinoma, and spiradenocarcinoma treated with MMS are also reviewed.
Conclusion:
The rarity of ACs and the lack of comparative data on treatment makes conclusive recommendations on treatment difficult. Recent large case series and reviews suggest MMS is a useful and possibly superior treatment for AC and should be considered if primary cutaneous disease is suspected.
Insights
Mohs micrographic surgery (MMS) is a valuable treatment for rare adnexal carcinomas (ACs). While recurrence and metastasis rates vary by AC type, MMS shows promise for primary cutaneous disease.
Area of Science:
- Dermatology
- Surgical Oncology
- Cutaneous Malignancies
Background:
- Adnexal carcinomas (ACs) are uncommon skin cancers originating from sweat glands or pilosebaceous units.
- Optimal treatment strategies and metastatic potential for ACs remain incompletely understood.
- Mohs micrographic surgery (MMS) is increasingly adopted for AC treatment.
Purpose of the Study:
- To evaluate treatment outcomes for primary cutaneous adnexal carcinomas using Mohs micrographic surgery.
- To review the efficacy and safety of MMS in managing various subtypes of ACs.
Main Methods:
- A comprehensive literature review was conducted using PubMed.
- Articles focusing on primary cutaneous adnexal carcinomas and their management with MMS were analyzed.
Main Results:
- Recurrence and metastasis rates after MMS varied by AC subtype, with specific data for sebaceous carcinoma, mucinous carcinoma, and microcystic AC.
- Trichilemmal carcinoma and hidradenocarcinoma showed no reported recurrences or metastases post-MMS.
- Eccrine porocarcinoma had regional lymph node metastases but no distant metastases or local recurrences after MMS.
Conclusions:
- The rarity and limited comparative data for ACs complicate definitive treatment recommendations.
- Current evidence suggests MMS is an effective and potentially superior option for primary cutaneous ACs.
- MMS should be strongly considered for suspected cases of primary cutaneous adnexal carcinoma.
