Microcystic adnexal carcinoma in a non-Caucasian patient: A case report and review of the literature

An atypical presentation of extensive centrofacial microcystic adnexal carcinoma responding to radiation: A case report and review of the literature

Microcystic adnexal carcinoma is a rare cutaneous neoplasm believed to arise from pluripotent keratinocytes capable of adnexal differentiation. Due to its insidious growth and appearance, diagnosis is often delayed. A deep incisional or excisional biopsy for histopathology is the gold standard for diagnosis. Different treatment modalities have been described in the literature, including the Mohs micrographic surgery, standard excision, radiation, chemotherapy, and observation. Currently, Mohs remains the treatment of choice. We present a unique case of a 12-month history of an extensive progressive centrofacial cutaneous induration diagnosed as microcystic adnexal carcinoma in an 83-year-old female. Due to the extensive nature of the tumor, she received radiation therapy and continues to receive ongoing assessment with no evidence of clinical recurrence at 2-year post-treatment including negative scouting biopsies. To date, there is no consensus on the optimal treatment for microcystic adnexal carcinoma.

Axillary and elbow lymph node metastasis arising after complete excision of microcystic adnexal carcinoma of a hand: A rare presentation

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MAC arising at a hand may require wider excision in order to achieve best result.

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The metastatic route could be explained the spreading via lymphatic system.

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CT scan renders more details and more precise diagnosis in a suspicious situation.

Introduction

Microcystic adnexal carcinoma (MAC), a malignant transformation of adnexal structures, constitutes a rare locally aggressive malignancy of skin. Generally, the disease is associated with local invasion and distant metastases are extremely rare. We presented a case of MAC with distant metastasis after adequate wide excision.

Presentation of case

A 65-year-old man presented with a scar-like lesion at his left hand’s middle finger. As pathologic result from incisional biopsy confirmed MAC, the patient was then treated with ray amputation. Eight years later, there was a presence of scar changes. There was a palpable node at medial epicondyle and presence of enlarged lymph nodes at axilla by imaging with Computed tomography (CT) scan. Following left hand amputation and node dissection at elbow and axillary region, pathologic examination confirmed recurrence and metastasis of MAC. He went through adjuvant radiation with a complete response. At present, two years after surgery, he remains in complete remission.

Discussion

The presence of a recurrent MAC with distant lymph node metastasis after primary surgery is rare. The metastatic route as presented with the positive nodes at elbow and axilla could be explained the spreading via lymphatic system.

Conclusion

MAC arising at a hand may require wider excision in order to achieve best result. Although this malignancy is a slowly progressive disease, distant metastasis should always be concerned, especially when there are suspicious presentations. CT scan will render more details and make more precise diagnosis in the suspicious situation.

[Microcystic adnexal carcinoma: A case report]

We report a case of microcystic adnexal carcinoma in a 80-year-old woman. This is a rare malignant adnexal cutaneous tumor with glandular and follicular differentiation, rare, often asymptomatic, with late diagnosis and slow growth, locally aggressive and rarely metastatic. The distinction with other benign and malignant skin tumors is difficult.