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Vol. 100. Issue 8.
Pages 693-699 (October 2009)
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Vol. 100. Issue 8.
Pages 693-699 (October 2009)
Original articles
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Microcystic Adnexal Carcinoma: Mohs Micrographic Surgery as the Treatment of Choice
Carcinoma Anexial Microquístico : la Cirugía Micrográfica de Mohs Como Tratamiento de Elección
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A. Martorell-Calatayuda,
Corresponding author
antmarto@hotmail.com

Correspondence: Antonio Martorell Calatayud, C/ San José de la Montaña, 14, puerta 11, 46008 Valencia, Spain.
, C. Requena-Caballeroa, R. Botella-Estradaa, S. Almenar-Medinab, O. Sanmartín-Jiméneza, B. Llombart-Cussaca, E. Nagore-Enguídanosa, C. Serra-Guilléna, B. Echeverría-Garcíaa, C. Guillén-Baronaa
a Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, Spain
b Servicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, Spain
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Abstract
Introduction and objectives

Microcystic adnexal carcinoma is a rare and aggressive tumor that manifests clinically as a subcutaneous nodule located on the head or neck. The tumor can be confused clinically and histologically with other benign and malignant skin lesions, often leading to inappropriate initial treatment. The chief concern with microcystic adnexal carcinoma is the elevated morbidity and the high rate of recurrence after wide local excision. Recent preliminary studies point to higher cure rates with Mohs micrographic surgery.

Material and methods

We reviewed the medical histories of 6 consecutive patients with microcystic adnexal carcinoma who underwent Mohs micrographic surgery in our dermatology department between 1995 and 2007.

Results

In all cases, lesions were located on the head and were primary tumors. Seventy percent of the tumors were wrongly diagnosed initially as basal cell carcinoma. Perineural invasion was not detected in any patient, and all were free of recurrence after between 1 and 12 years of postoperative follow-up.

Conclusions

The absence of perineural involvement and substantial cell atypia can be attributed to the lesions being primary tumors. This would provide a rationale for definitive radical treatment of the primary tumor from the outset to avoid the complications associated with recurrence. The site and the absence of recurrence in all our patients who underwent Mohs micrographic surgery support the use of this technique as the treatment of choice in microcystic adnexal carcinoma.

Key words:
microcystic adnexal carcinoma
Mohs surgery
perineural invasion
Resumen
Introducción y objetivos

El carcinoma anexial microquístico (CAM) es un tumor raro y agresivo que clínicamente se manifiesta como un nódulo subcutáneo localizado en las regiones de cabeza y cuello. Esta tumoración puede ser clínica e histológicamente confundida con otras lesiones cutáneas benignas o malignas, loque con frecuencia conduce a un tratamiento inicial erróneo. La principal complicación del CAM es la alta morbilidad y la elevada tasa de recurrencia tras escisión local amplia. Estudios preliminares recientes han mostrado unas mayores tasas de curación mediante cirugía micrográfica de Mohs (CMM).

Material y métodos

Se revisaron las historias clínicas de 6 pacientes consecutivos con CAM tratados mediante CMM en nuestro Servicio de Dermatología entre 1995 y 2007.

Resultados

Todos los casos se localizaron en la cabeza y el 100% fue tumor primario. En el 70% de los casos el tumor fue inicialmente mal diagnosticado de carcinoma basocelular. No se detectó invasión perineural en ninguno de los casos y la recurrencia estuvo ausente en todos los pacientes tras un periodo de seguimiento comprendido entre 1 y 12 años posteriores a la CMM.

Conclusiones

La ausencia de afectación perineural y de una importante atipia celular puede deberse al carácter primario de la tumoración. Ello justificaría la necesidad de un tratamiento definitivo radical inicial del tumor primario para evitar las complicaciones que implica una recidiva tumoral. La localización y la ausencia de recurrencia en todos nuestros casos tratados mediante CMM apoyan el uso de esta técnica como el tratamiento de elección para el CAM.

Palabras clave:
carcinoma anexial microquístico
cirugía de Mohs
invasión perineural
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