Primary Cutaneous Apocrine Carcinoma With Locoregional Disease: A Proposed Diagnostic and Therapeutic Framework

Primary cutaneous apocrine carcinoma (PCAC) is a rare, low-grade cutaneous malignancy for which no standardized diagnostic or treatment algorithm currently exists. Clinical resemblance to other cutaneous malignancies and histopathologic overlap with other metastatic lesions often contribute to delays in diagnosis or misdiagnoses. Management is centered on wide-local-excision (WLE) and consideration of sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) as standard-of-care. We present a case of PCAC with locoregional metastasis. We propose a novel, systematic framework to guide clinicians in the diagnosis and management of this uncommon tumor. This addresses a critical gap in the existing literature.