Dermatologic Surgery
Microcystic adnexal carcinoma: Treatment with Mohs micrographic surgery

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Background

Microcystic adnexal carcinoma (MAC) is reported to have a high rate of recurrence with standard wide local excision.

Objective

To report a large series of patients with MAC treated with Mohs micrographic surgery (MMS).

Methods

This prospective, multi-center case series included all patients in Australia treated with MMS for MAC, who were monitored by the Skin and Cancer Foundation between 1993 and 2002.

Results

There were 44 cases; most of them (90.9%) were located in the head and neck area. In 31.8% of cases it was a recurrent tumor. In 32.5% of cases the tumor was initially misdiagnosed as basal cell carcinoma or squamous cell carcinoma. Perineural invasion was recorded in 17.5% of cases; most of them (85.7%) were previously recurrent tumors. There was only one case of recurrence (5%) out of 20 patients who completed a 5 year follow-up period after MMS.

Conclusion

The low 5-year recurrence rate of MAC with MMS emphasizes the importance of margin-controlled excision.

Section snippets

Method

This is a prospective, non-comparative, multi-center, interventional case series of patients with MAC treated with MMS in Australia and monitored by the Skin and Cancer Foundation, between 1993 and 2002. All patients were treated by an accredited Mohs surgeon, using standard fresh-frozen MMS techniques. Data was collected by the Skin and Cancer Foundation.

The criteria for selection were all cases with MAC diagnosed histologically and treated with MMS. The following parameters were recorded:

Statistical analysis

Associations between categorical variables were analyzed using chi-square tests, with the Mantel-Haenszel test for linear association where appropriate. The Wilcoxon signed rank test was used for non-normally distributed data. Exact 95% confidence intervals (CI) were calculated for the recurrence rates. Analyses were performed using SAS Version 8.2 (SAS Institute Inc, Cary, NC).

Results

Forty-four patients with 44 tumors were included in the study. There were 21 males and 23 females; mean age was 54 ± 19 years (median, 55.5 years; range, 10-86 years). Forty out of the 44 tumors (90.9%) were located in the head and neck area, mainly on the cheek (12 patients, 27.3%) and nose (9 patients, 20.5%). Only 4 tumors were located outside the head and neck area (9.1%) (Table I). The most common reason for referral for MMS was tumor type (26 patients, 59.1%) (Table II).

Tumor age before

Discussion

Malignant skin adnexal tumors arising from sweat glands are not common. MAC is a slowly growing, locally aggressive tumor that was recognized as a specific clinical entity as recently as 1982.1 The rarity of this tumor, the pattern of growth, and its fairly recent description, has resulted in only a small number of publications evaluating the best treatment options. Our study, to the best of our knowledge, is the largest prospective series reporting the effectiveness of MMS in treating MAC.

The

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  • Cited by (104)

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      Citation Excerpt :

      Microcystic adnexal carcinoma is frequently treated with MMS due to considerable local subclinical spread and perineural invasion.130 Recurrence rates after MMS range from 4.3% to 5.7%,129–131 whereas wide local excision recurrence rates range from 17% to 60%.129 Sebaceous carcinoma, both periocular and extraocular, has been successfully treated with MMS.129

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    Funding sources: None.

    Conflicts of interest: None identified.

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