Eccrine Carcinoma

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Author: Anthony Wong, MD, FAAD; Chief Editor: Dirk M Elston, MD more...

Updated: Mar 26, 2010

Background

Carcinomas of the eccrine sweat gland represent a rare group of tumors with potential for local destruction andmetastasis. High recurrence rates have been reported following conventional surgical excision of eccrine carcinomas.The specific classification of eccrine carcinomas is both complex and nebulous, in large part because of the paucity of reported cases but also because many of these tumors show little histologic resemblance to mature eccrine glands;the histogenetic association is based primarily on histochemical, immunochemical, or ultrastructural features.Nevertheless, eccrine carcinomas may be taxonomically segregated into 2 main groups, as follows: those that arehistologically similar to certain benign appendage tumors (eg, sclerosing sweat duct carcinoma, porocarcinoma,malignant chondroid syringoma, malignant nodular hidradenoma, malignant eccrine spiradenoma) and those that show

a diverse array of histologic features, not recapitulating to any degree aspects of a benign counterpart.

A slightly different method of eccrine carcinoma classification is suggested by Galadari et al, [1] who divide thesetumors into those that arise de novo in normal skin and those that originate within preexisting benign sweat glandtumors. Precise identification based on histology is of significant importance because therapy and prognosis varyaccording to microscopic appearance (see Histologic Findings).

Pathophysiology

Eccrine carcinoma may be derived de novo from any portion of the normal eccrine apparatus or result from thetransformation of an existing benign eccrine tumor.

A 2000 study by Takata et al [2] examining the incidence of cytogenetic abnormalities in malignant eccrine tumors

showed low incidences of loss of heterozygosity (LOH) or TP53 alterations in a mixed group of these neoplasms, incontrast to the frequent and multiple genetic abnormalities seen in tumors arising from epidermal keratinocytes. Theauthors speculate that this difference may be partly explained by the fact that the bulk of a sweat gland lies deep in thedermis where it is relatively protected from the sun and environmental mutagens. The precise role of ultravioletradiation (UVR) remains to be elucidated, as another study analyzing TP53 mutations in 16 sweat gland carcinomasidentified 3 G:C A:T transitions at dipyrimidine sequences on the antisense strand. [3]

Abbate et al [4] suggest that genetics may play a role in the development of microcystic adnexal carcinoma (MAC).

Epidemiology

Frequency

United States

Primary eccrine carcinomas are exceedingly rare, accounting for roughly 1 of 13,000 specimens submitted to adermatopathology laboratory. The more common subtypes include microcystic adnexal carcinoma, eccrineporocarcinoma, and hidradenocarcinoma. The less common subtypes include eccrine mucinous carcinoma, malignanteccrine spiradenoma, malignant mixed tumor, malignant cylindroma, and papillary eccrine adenoma.

International

Only several hundred cases of eccrine carcinoma have been reported in the literature worldwide. No specific data areavailable regarding United States versus international incidence of eccrine carcinoma.

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Mortality/Morbidity

Data regarding precise figures for eccrine carcinoma are insufficient; however, many of these tumors metastasize (upto 60%), with a fatal outcome.

Race

MAC was previously only described in white patients; however, Peterson et al [5] and Gardner et al [6] report the first andsecond cases of MAC affecting African Americans, respectively.

Sex

Sex incidence would appear to be equal for eccrine carcinoma, although this has not been definitively stated.Exceptions to this are the malignant chondroid syringoma and primary cutaneous adenoid cystic eccrine carcinoma,both of which occur more commonly in females than in males.

Age

Eccrine carcinomas most commonly are diagnosed in patients in their fifth through eighth decades of life.

Contributor Information and DisclosuresAuthor Anthony Wong, MD, FAAD Consulting Staff, Department of Dermatology, SUNY Health Science Center atBrooklyn, St Catherine's of Sienna, and Long Island Skin Cancer and Dermatologic Surgery, PC

Anthony Wong, MD, FAAD is a member of the following medical societies: American Academy of Dermatology andAmerican College of Mohs Micrographic Surgery and Cutaneous Oncology

Disclosure: Nothing to disclose.

Coauthor(s)Darren Keith Mollick, MD Clinical Assistant Professor, Department of Dermatology, State University of New YorkDownstate Medical Center


Daniel Mark Siegel, MD, MS Director, Procedural Dermatology Fellowship Program, Clinical Professor of Dermatology, Department of Dermatology, State University of New York Downstate

Daniel Mark Siegel, MD, MS is a member of the following medical societies: American Academy of Dermatology ,American College of Mohs Micrographic Surgery and Cutaneous Oncology , American College of PhysicianExecutives , American Society for Dermatologic Surgery , American Society for MOHS Surgery , and InternationalSociety for Dermatologic Surgery


Specialty Editor BoardR Stan Taylor, MD Professor of Dermatology, University of Texas Southwestern Medical School; Director of SkinSurgery and Oncology Clinic, Department of Dermatology, University of Texas Southwestern Medical Center

R Stan Taylor, MD is a member of the following medical societies: American Academy of Dermatology , AmericanCollege of Mohs Surgery, American Dermatological Association , American Medical Association , American Societyfor Dermatologic Surgery , Christian Medical & Dental Society , and Society for Investigative Dermatology


Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology ,Association of Military Dermatologists , Texas Dermatological Society , and Texas Medical Association


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Mary Farley, MD Dermatologic Surgeon/Mohs Surgeon, Anne Arundel Surgery Center


Glen H Crawford, MD Assistant Clinical Professor, Department of Dermatology, University of PennsylvaniaSchool of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha , American Academy of

Dermatology , American Medical Association , Phi Beta Kappa , and Society of USAF Flight Surgeons


Chief Editor Dirk M Elston, MD Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology


References

Galadari E, Mehregan AH, Lee KC. Malignant transformation of eccrine tumors. J Cutan Pathol . Feb1987;14(1):15-22. [Medline] .

1.

Takata M, Hashimoto K, Mehregan P, et al. Genetic changes in sweat gland carcinomas. J Cutan Pathol . Jan2000;27(1):30-5. [Medline] .

2.

Biernat W, Peraud A, Wozniak L, Ohgaki H. p53 mutations in sweat gland carcinomas. Int J Cancer . May 41998;76(3):317-20. [Medline] .

3.

Abbate M, Zeitouni NC, Seyler M, Hicks W, Loree T, Cheney RT. Clinical course, risk factors, and treatment of microcystic adnexal carcinoma: a short series report. Dermatol Surg . Oct 2003;29(10):1035-8. [Medline] .

4.

Peterson CM, Ratz JL, Sangueza OP. Microcystic adnexal carcinoma: First reported case in an AfricanAmerican man. J Am Acad Dermatol . Aug 2001;45(2):283-5. [Medline] .

5.

Gardner ES, Goldberg LH. Neglected microcystic adnexal carcinoma: the second reported case in a blackpatient. Dermatol Surg . Jul 2001;27(7):678-80. [Medline] .

6.

Chauhan A, Ganguly M, Takkar P, Dutta V. Primary mucinous carcinoma of eyelid: a rare clinical entity. Indian J Ophthalmol . Mar-Apr 2009;57(2):150-2. [Medline] .

7.

Bannur HB, Mastiholimath RD, Malur PR. Primary mucinous eccrine adenocarcinoma of the scalp: a casereport. Acta Cytol . Nov-Dec 2009;53(6):698-700. [Medline] .

8.

Chiller K, Passaro D, Scheuller M, Singer M, McCalmont T, Grekin RC. Microcystic adnexal carcinoma:forty-eight cases, their treatment, and their outcome. Arch Dermatol . Nov 2000;136(11):1355-9. [Medline] .

9.

Harwood CA, McGregor JM, Swale VJ, et al. High frequency and diversity of cutaneous appendageal tumors

in organ transplant recipients. J Am Acad Dermatol . Mar 2003;48(3):401-8. [Medline] .

10.

Scholz IM, Hartschuh W. Primary mucinous eccrine carcinoma of the skin - a rare clinical tumor with manydifferential diagnoses. J Dtsch Dermatol Ges . Oct 13 2009; [Medline] .

11.

Wildemore JK, Lee JB, Humphreys TR. Mohs surgery for malignant eccrine neoplasms. Dermatol Surg . Dec2004;30(12 Pt 2):1574-9. [Medline] .

12.

Penneys NS, Zlatkiss I. Immunohistochemical demonstration of ferritin in sweat gland and sweat glandneoplasms. J Cutan Pathol . Feb 1990;17(1):32-6. [Medline] .

13.

Yeung KY, Stinson JC. Mucinous (adenocystic) carcinoma of sweat glands with widespread metastasis. Casereport with ultrastructural study. Cancer . Jun 1977;39(6):2556-62. [Medline] .

14.


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4/4

Medscape Reference 2011 WebMD, LLC

Snow S, Madjar DD, Hardy S, et al. Microcystic adnexal carcinoma: report of 13 cases and review of theliterature. Dermatol Surg . Apr 2001;27(4):401-8. [Medline] .

15.

Lozano Orella JA, Valcayo Penalba A, San Juan CC, et al. Eccrine porocarcinoma. Report of nine cases.Dermatol Surg . Oct 1997;23(10):925-8. [Medline] .

16.

Mehregan AH, Hashimoto K, Rahbari H. Eccrine adenocarcinoma. A clinicopathologic study of 35 cases.Arch Dermatol . Feb 1983;119(2):104-14. [Medline] .

17.

Lober CW, Larbig GG. Microcystic adnexal carcinoma (sclerosing sweat duct carcinoma). South Med J . Feb

1994;87(2):259-62. [Medline] .

18.

Moy RL, Rivkin JE, Lee H, Brooks WS, Zitelli JA. Syringoid eccrine carcinoma. J Am Acad Dermatol . May1991;24(5 Pt 2):857-60. [Medline] .

19.

Duke WH, Sherrod TT, Lupton GP. Aggressive digital papillary adenocarcinoma (aggressive digital papillaryadenoma and adenocarcinoma revisited). Am J Surg Pathol . Jun 2000;24(6):775-84. [Medline] .

20.

Cabell CE, Helm KF, Sakol PJ, Billingsley EM. Primary mucinous carcinoma in a 54-year-old man. J Am Acad Dermatol . Nov 2003;49(5):941-3. [Medline] .

21.

Cooper PH, Adelson GL, Holthaus WH. Primary cutaneous adenoid cystic carcinoma. Arch Dermatol . Jun1984;120(6):774-7. [Medline] .

22.

Goel R, Contos MJ, Wallace ML. Widespread metastatic eccrine porocarcinoma. J Am Acad Dermatol . Nov2003;49(5 Suppl):S252-4. [Medline] .23.

Harrist TJ, Aretz TH, Mihm MC Jr, Evans GW, Rodriquez FL. Cutaneous malignant mixed tumor. Arch Dermatol . Nov 1981;117(11):719-24. [Medline] .

24.

Hashimoto K, Mehregan AH, Kumakiri M. Tumors of Skin Appendages . Boston, Mass: Butterworth; 1987.25.

Mitsui H, Watanabe T, Jinnin M, Kadono T, Idezuki T, Tamaki K. Mucinous carcinoma of the skin could haveeither an eccrine or an apocrine origin. Br J Dermatol . Dec 2004;151(6):1285-6. [Medline] .

26.

Murphy GF, Elder DE. Non melanocytic tumors of the skin. In: Atlas of Tumor Pathology . 3rd Series. Fascicle1. Washington DC: Armed Forces Institute of Pathology; 1991.

27.

Wick MR, Swanson PE, Kaye VN, Pittelkow MR. Sweat gland carcinoma ex eccrine spiradenoma. Am J Dermatopathol . Apr 1987;9(2):90-8. [Medline] .28.

Yildirim S, Akz T, Akan M, Ege GA. De novo malignant eccrine spiradenoma with an interesting and unusuallocation. Dermatol Surg . Apr 2001;27(4):417-20. [Medline] .

29.


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Eccrine Carcinoma