eMedicine Specialties > Dermatology > Malignant Neoplasms

Eccrine Carcinoma: Differential Diagnoses & Workup

Author: Anthony Wong, MD, FAAD, Consulting Staff, Department of Dermatology, SUNY Health Science Center at Brooklyn, St Catherine's of Sienna, and Long Island Skin Cancer and Dermatologic Surgery, PC
Coauthor(s): Darren Keith Mollick, MD, Clinical Assistant Professor, Department of Dermatology, State University of New York Downstate 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; Aza Lefkowitz, MD, Consulting Staff, Advanced Dermatology, PC
Contributor Information and Disclosures

Updated: Oct 14, 2008

Differential Diagnoses

Basal Cell Carcinoma
Merkel Cell Carcinoma
Metastatic Carcinoma of the Skin
Squamous Cell Carcinoma

Workup

Imaging Studies

  • Because of the rarity of these tumors, specific guidelines for the investigation of possible disseminated disease have not been established.

Procedures

  • A shave, punch, or excisional biopsy should be performed to obtain a representative sample of the lesion; this sample should be sent for histopathologic evaluation to make the initial diagnosis.
  • Because of the high rate of local recurrence (10-70%) and subsequent metastasis (up to 60%) following conventional surgical excision, Mohs micrographic surgery appears to be the method of choice for removal of eccrine carcinomas. Wildemore et al9 reported on 19 cases of non-MAC malignant eccrine neoplasms that were treated by Mohs micrographic surgery. No reported recurrences were found over an average follow-up period of 29 months.

Histologic Findings

Several eccrine carcinoma subtypes bear histologic resemblance to a well-described benign counterpart; these tumors are named accordingly, and the microscopic distinction between benign and malignant usually is made based on extent of invasion, asymmetry at scanning magnification, and degree of nuclear atypia. In contrast, the group of primary eccrine cancers without features of benign adnexal tumors is less readily recognizable and includes eccrine adenocarcinoma, mucinous eccrine carcinoma, adenoid cystic eccrine carcinoma, and aggressive digital papillary adenoma/adenocarcinoma. These tumors often may be confused with visceral adenocarcinoma metastatic to the skin and represent important diagnostic considerations when adenocarcinoma is encountered in the skin in the absence of a known extracutaneous primary.

Eccrine adenocarcinoma generally resembles a moderately to poorly differentiated adenocarcinoma, with regional variation ranging from true ductules in some areas to infiltrative, nonglandular anaplastic cells in other areas, to glycogenated cellular zones in other areas. Contiguity with benign eccrine structures or with overlying epidermis is not seen.

Mucinous eccrine carcinoma is characterized histologically by solitary and nested anaplastic cells floating in pools of mucin within the dermis. Thin strands of fibrous tissue serve to compartmentalize these "lakes" of mucin.

Adenoid cystic eccrine carcinomas most often are seen as tumors of major and minor salivary glands but rarely may be encountered as primary cutaneous tumors remote from salivary apparatus. This tumor exhibits a population of uniform basaloid cells forming cribriform and tubular structures, usually with evidence of mucin and of hyaline surrounding cellular masses. Perineural invasion is prevalent and should be sought specifically.

Aggressive digital papillary adenoma/adenocarcinoma exhibits cystic zones manifesting papillary infoldings and lined with benign cuboidal epithelium, more cellular zones of atypical adenomatous hyperplasia, and areas of overt adenocarcinoma. Whether aggressive digital papillary adenoma (ADPA) can be distinguished histologically from aggressive digital papillary adenocarcinoma (ADPA) has been questioned; it now is advised that all aggressive digital papillary (ADP) tumors be designated as adenocarcinoma.

Notwithstanding the above histologic descriptions, the distinction between subtypes and even the designation of eccrine tumor may be difficult, if not impossible, in select cases based on light microscopy alone. In these instances, a stain of eccrine-type enzymes (eg, succinic dehydrogenase, amylophosphorylase) may be obtained. The presence of ferritin also is helpful in determining the eccrine origin of a tumor10 ; such immunostains as CEA, EMA, EKH5, and EKH6 also may be used.

More on Eccrine Carcinoma

Overview: Eccrine Carcinoma
Differential Diagnoses & Workup: Eccrine Carcinoma
Treatment & Medication: Eccrine Carcinoma
Follow-up: Eccrine Carcinoma
References
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References

  1. Galadari E, Mehregan AH, Lee KC. Malignant transformation of eccrine tumors. J Cutan Pathol. Feb 1987;14(1):15-22. [Medline].

  2. Takata M, Hashimoto K, Mehregan P, Lee MW, Yamamoto A, Mohri S, et al. Genetic changes in sweat gland carcinomas. J Cutan Pathol. Jan 2000;27(1):30-5. [Medline].

  3. Biernat W, Peraud A, Wozniak L, Ohgaki H. p53 mutations in sweat gland carcinomas. Int J Cancer. May 4 1998;76(3):317-20. [Medline].

  4. 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].

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

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

  7. 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].

  8. Harwood CA, McGregor JM, Swale VJ, Proby CM, Leigh IM, Newton R, 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].

  9. Wildemore JK, Lee JB, Humphreys TR. Mohs surgery for malignant eccrine neoplasms. Dermatol Surg. Dec 2004;30(12 Pt 2):1574-9. [Medline].

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

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

  12. Snow S, Madjar DD, Hardy S, Bentz M, Lucarelli MJ, Bechard R, et al. Microcystic adnexal carcinoma: report of 13 cases and review of the literature. Dermatol Surg. Apr 2001;27(4):401-8. [Medline].

  13. Lozano Orella JA, Valcayo Peñalba A, San Juan CC, Vives Nadal R, Castro Morrondo J, Tuñon Alvarez T. Eccrine porocarcinoma. Report of nine cases. Dermatol Surg. Oct 1997;23(10):925-8. [Medline].

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

  15. Lober CW, Larbig GG. Microcystic adnexal carcinoma (sclerosing sweat duct carcinoma). South Med J. Feb 1994;87(2):259-62. [Medline].

  16. Moy RL, Rivkin JE, Lee H, Brooks WS, Zitelli JA. Syringoid eccrine carcinoma. J Am Acad Dermatol. May 1991;24(5 Pt 2):857-60. [Medline].

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

  18. 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].

  19. Cooper PH, Adelson GL, Holthaus WH. Primary cutaneous adenoid cystic carcinoma. Arch Dermatol. Jun 1984;120(6):774-7. [Medline].

  20. Goel R, Contos MJ, Wallace ML. Widespread metastatic eccrine porocarcinoma. J Am Acad Dermatol. Nov 2003;49(5 Suppl):S252-4. [Medline].

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

  22. Hashimoto K, Mehregan AH, Kumakiri M. Tumors of Skin Appendages. Boston, Mass: Butterworth; 1987.

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

  24. Murphy GF, Elder DE. Non melanocytic tumors of the skin. In: Atlas of Tumor Pathology. 3rd Series. Fascicle 1. Washington DC: Armed Forces Institute of Pathology; 1991.

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

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

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Further Reading

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Keywords

eccrine carcinoma, eccrine adenocarcinoma, malignant tumors with eccrine differentiation, EC

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Contributor Information and Disclosures

Author

Anthony Wong, MD, FAAD, Consulting Staff, Department of Dermatology, SUNY Health Science Center at Brooklyn, 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 and American 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 York Downstate Medical Center
Disclosure: Nothing to disclose.

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 Academy of Facial Plastic and Reconstructive Surgery, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American College of Physician Executives, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, American Society for MOHS Surgery, and International Society for Dermatologic Surgery
Disclosure: Nothing to disclose.

Aza Lefkowitz, MD, Consulting Staff, Advanced Dermatology, PC
Aza Lefkowitz, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Medical Editor

R Stan Taylor, MD, Professor of Dermatology, University of Texas Southwestern Medical School; Director of Skin Surgery 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, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Medical Association, American Society for Dermatologic Surgery, Christian Medical & Dental Society, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

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
Disclosure: Nothing to disclose.

Managing Editor

Mary Farley, MD, Dermatologic Surgeon/Mohs Surgeon, Anne Arundel Surgery Center
Disclosure: Nothing to disclose.

CME Editor

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School 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
Disclosure: Nothing to disclose.

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
Disclosure: Nothing to disclose.

 
 
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