[Chemotherapy of advanced adenocarcinoma of the skin]

Sweat gland carcinomas are rare malignant tumors of the skin. Primary treatment consists of wide local excision with regional lymph node dissection. Distant metastasis of sweat gland carcinomas are reputed to have a very poor prognosis because of their chemo-resistance. Most trials of chemotherapy have failed. Numerous single agents have been investigated in this disease. In only one case did 5-fluorouracil result in a complete response. Experience with combination chemotherapy in metastatic disease is limited; only several complete responses and partial responses have been reported. In the literature, we found reports on several cases of sweat gland carcinoma with overt disease, which had been treated with different chemotherapeutic agents in various combinations. These studies have suggested the efficacy of doxorubicin, cyclophosphamide, mitomycin C, vincristine, cisplatin, 5-fluorouracil, bleomycin and melpharan used in combinations. We tried a new drug combination consisting of epirubicin, mitomycin C, vincristine, carboplatin and 5-fluorouracil. After one course of such treatment, the metastatic lesion reduced greatly in size. Advanced extramammary Paget's disease is also an adenocarcinoma of the skin. The recommended treatment for localized extramammary Paget's disease is wide margin resection. The role of therapy in advanced unresectable extramammary Paget's disease is not established. We reviewed systemic chemotherapy of extramammary Paget's disease in the literature, but only a few complete and partial responses were reported. In sweat gland carcinoma and extramammary Paget's disease, the efficacy of chemotherapy is undetermined. Larger, group-wide trials are needed to prospectively evaluate the use of chemotherapy in these diseases.