A case of primary mucinous carcinoma of the scalp treated with mohs surgery

[Primary mucinous carcinoma of the eyelid. Case report]

Primary cutaneous mucinous carcinoma, a tumor of the sweat glands, is a rare tumor localized to the eyelid in 40% of cases. We report a case of a primary cutaneous mucinous carcinoma of the upper eyelid in a 53-year-old Caucasian male who appeared to have a chalazion. Histology showed rows and lobules of epithelial cells with discretely anisonucleotic nuclei and few mitotic figures scattered throughout the tumor cells, surrounded by a mucoid substance. Immunohistochemical analysis was cytokeratin 7 positive and cytokeratin 20 negative, and imaging and endoscopic screening were negative for metastasis, favoring the diagnosis of primary cutaneous mucinous carcinoma. Despite a high recurrence rate of about 35%, this type of tumor displays an indolent course, and metastatic spread is very rare.

Primary mucinous carcinoma of the skin: a case of metastasis after 10 years of disease-free interval

Primary mucinous carcinoma of the skin (MCS) is a rare neoplasm. Clinically, it has a high local recurrence rate, but it is known to be a slow-growing benign tumor with a rare incidence of distant metastases. We present a case of primary MCS on the jaw that underwent tumor resection twice and was disease-free for 10 years after the second surgery. The patient had no evidence of local recurrence and distant metastasis until his 11th year follow-up. At that time, he was diagnosed with lung and bone metastasis and died 3 years after this. To our knowledge, this is the first case of MCS that presented with metastasis with more than 10-year disease-free interval. Since MCS is a slow-growing asymptomatic tumor, distant metastasis is difficult to diagnose without detailed radiological examination. We believe that computed tomography and resonance imaging should be performed for early diagnosis of metastasis even for cases with long-term disease-free interval, especially cases of local recurrence.

Carcinome mucineux primitif cutané

Primary mucinous carcinoma of the skin is a rare sweat-gland neoplasm with a high recurrence rate. We report a new case of a primary recurrent mucinous carcinoma of the face in a 59-year-old man. Histopathologic examination of the neoplasm showed epithelial islands floating in mucoid material compartmentalized by fibrous septa. Cytokeratin 7, protein S100, estrogen and progesterone receptors were detected at immunohistochemical study, while cytokeratin 20 and actin were undetectable. Histologically, mucinous carcinoma of the skin can be mistaken for a metastasis from extracutaneous sites, particularly the breast or the gastrointestinal tract. Mucinous carcinoma of the skin has a relatively good prognosis with rare distant metastases, but high recurrence rate.

Oestrogen and progesterone receptors in primary mucinous carcinoma of skin

A 74-year-old man presented with a recurrent indolent growth in the left axilla. Fine-needle aspiration cytology and histopathological examination showed a picture of mucinous adenocarcinoma. Clinical examination and systemic investigations failed to detect any primary lesion elsewhere and hence, a diagnosis of primary mucinous carcinoma of the skin was made. This tumour shows histological resemblance to mucinous carcinoma of breast. We also demonstrated expression of oestrogen and progesterone receptors in this tumour. This observation suggests that there is a potential of using antioestrogenic therapy in patients with primary cutaneous mucinous carcinoma, especially because of its high rate of local recurrence.

Mohs Micrographic Surgery of Primary Cutaneous Mucinous Carcinoma Using Immunohistochemistry for Margin Control

BACKGROUND

Primary cutaneous mucinous carcinoma is a rare adnexal malignancy with a high recurrence rate following conventional excision and the potential for aggressive local invasion.

OBJECTIVE

To enhance the microscopic detection of mucinous carcinoma in Mohs micrographic surgical sections by incorporating rapid immunohistochemical staining.

METHODS

Standard Mohs micrographic surgical technique was used in conjunction with frozen section immunohistochemistry using an antibody to low-molecular-weight cytokeratin.

RESULTS

Rapid immunoperoxidase staining using low-molecular-weight cytokeratin detected residual foci of mucinous carcinoma that were difficult to identify on routine frozen sections. Immunostaining was strongly positive in areas with clear evidence of tumor by routine histology, as well as in adjacent areas on a subsequent stage where frozen sections were equivocal or negative. Immunostaining was distinctly negative at the final surgical margin, which was shown by en face permanent sections to be free of tumor. The patient has been free of recurrence for 3 years.

CONCLUSION

Immunoperoxidase-guided Mohs micrographic surgery using low-molecular-weight cytokeratin enhances the sensitivity for detection of mucinous carcinoma, and may help contribute to complete tumor removal.