Eccrine Carcinoma Workup
- Author: Anthony Wong, MD, FAAD; Chief Editor: Dirk M Elston, MD more...
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Because of the rarity of eccrine carcinomas, specific guidelines for the investigation of possible disseminated disease have not been established.
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A shave, punch, or excisional biopsy should be performed to obtain a representative sample of the eccrine carcinoma 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 al  reported on 19 cases of non–microcystic adnexal carcinoma (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.
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 tumor ; such immunostains as CEA, EMA, EKH5, and EKH6 also may be used.
Galadari E, Mehregan AH, Lee KC. Malignant transformation of eccrine tumors. J Cutan Pathol. 1987 Feb. 14(1):15-22. [Medline].
Takata M, Hashimoto K, Mehregan P, et al. Genetic changes in sweat gland carcinomas. J Cutan Pathol. 2000 Jan. 27(1):30-5. [Medline].
Biernat W, Peraud A, Wozniak L, Ohgaki H. p53 mutations in sweat gland carcinomas. Int J Cancer. 1998 May 4. 76(3):317-20. [Medline].
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. 2003 Oct. 29(10):1035-8. [Medline].
Peterson CM, Ratz JL, Sangueza OP. Microcystic adnexal carcinoma: First reported case in an African American man. J Am Acad Dermatol. 2001 Aug. 45(2):283-5. [Medline].
Gardner ES, Goldberg LH. Neglected microcystic adnexal carcinoma: the second reported case in a black patient. Dermatol Surg. 2001 Jul. 27(7):678-80. [Medline].
Bannur HB, Mastiholimath RD, Malur PR. Primary mucinous eccrine adenocarcinoma of the scalp: a case report. Acta Cytol. 2009 Nov-Dec. 53(6):698-700. [Medline].
Kim JW, Jeon MK, Kang SJ, Sun H. Surgical management of recurrent squamoid eccrine ductal carcinoma of the scalp. J Craniofac Surg. 2012 Jul. 23(4):e276-8. [Medline].
Coan EB, Doan A, Allen C. Mucinous eccrine carcinoma: a rare case of recurrence with lacrimal gland extension. Ophthal Plast Reconstr Surg. 2012 Sep-Oct. 28(5):e109-10. [Medline].
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. 2000 Nov. 136(11):1355-9. [Medline].
Harwood CA, McGregor JM, Swale VJ, et al. High frequency and diversity of cutaneous appendageal tumors in organ transplant recipients. J Am Acad Dermatol. 2003 Mar. 48(3):401-8. [Medline].
Scholz IM, Hartschuh W. Primary mucinous eccrine carcinoma of the skin - a rare clinical tumor with many differential diagnoses. J Dtsch Dermatol Ges. 2009 Oct 13. [Medline].
Wildemore JK, Lee JB, Humphreys TR. Mohs surgery for malignant eccrine neoplasms. Dermatol Surg. 2004 Dec. 30(12 Pt 2):1574-9. [Medline].
Le LP, Dias-Santagata D, Pawlak AC, Cosper AK, Nguyen AT, Selim MA, et al. Apocrine-eccrine carcinomas: molecular and immunohistochemical analyses. PLoS One. 2012. 7(10):e47290. [Medline]. [Full Text].
Penneys NS, Zlatkiss I. Immunohistochemical demonstration of ferritin in sweat gland and sweat gland neoplasms. J Cutan Pathol. 1990 Feb. 17(1):32-6. [Medline].
Yeung KY, Stinson JC. Mucinous (adenocystic) carcinoma of sweat glands with widespread metastasis. Case report with ultrastructural study. Cancer. 1977 Jun. 39(6):2556-62. [Medline].
Snow S, Madjar DD, Hardy S, et al. Microcystic adnexal carcinoma: report of 13 cases and review of the literature. Dermatol Surg. 2001 Apr. 27(4):401-8. [Medline].
Lozano Orella JA, Valcayo Penalba A, San Juan CC, et al. Eccrine porocarcinoma. Report of nine cases. Dermatol Surg. 1997 Oct. 23(10):925-8. [Medline].
Mehregan AH, Hashimoto K, Rahbari H. Eccrine adenocarcinoma. A clinicopathologic study of 35 cases. Arch Dermatol. 1983 Feb. 119(2):104-14. [Medline].
Lober CW, Larbig GG. Microcystic adnexal carcinoma (sclerosing sweat duct carcinoma). South Med J. 1994 Feb. 87(2):259-62. [Medline].
Moy RL, Rivkin JE, Lee H, Brooks WS, Zitelli JA. Syringoid eccrine carcinoma. J Am Acad Dermatol. 1991 May. 24(5 Pt 2):857-60. [Medline].
Duke WH, Sherrod TT, Lupton GP. Aggressive digital papillary adenocarcinoma (aggressive digital papillary adenoma and adenocarcinoma revisited). Am J Surg Pathol. 2000 Jun. 24(6):775-84. [Medline].
Cabell CE, Helm KF, Sakol PJ, Billingsley EM. Primary mucinous carcinoma in a 54-year-old man. J Am Acad Dermatol. 2003 Nov. 49(5):941-3. [Medline].
Cooper PH, Adelson GL, Holthaus WH. Primary cutaneous adenoid cystic carcinoma. Arch Dermatol. 1984 Jun. 120(6):774-7. [Medline].
Goel R, Contos MJ, Wallace ML. Widespread metastatic eccrine porocarcinoma. J Am Acad Dermatol. 2003 Nov. 49(5 Suppl):S252-4. [Medline].
Harrist TJ, Aretz TH, Mihm MC Jr, Evans GW, Rodriquez FL. Cutaneous malignant mixed tumor. Arch Dermatol. 1981 Nov. 117(11):719-24. [Medline].
Hashimoto K, Mehregan AH, Kumakiri M. Tumors of Skin Appendages. Boston, Mass: Butterworth; 1987.
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. 2004 Dec. 151(6):1285-6. [Medline].
Murphy GF, Elder DE. Non melanocytic tumors of the skin. Atlas of Tumor Pathology. Fascicle 1. Washington DC: Armed Forces Institute of Pathology; 1991. 3rd Series:
Wick MR, Swanson PE, Kaye VN, Pittelkow MR. Sweat gland carcinoma ex eccrine spiradenoma. Am J Dermatopathol. 1987 Apr. 9(2):90-8. [Medline].
Yildirim S, Aköz T, Akan M, Ege GA. De novo malignant eccrine spiradenoma with an interesting and unusual location. Dermatol Surg. 2001 Apr. 27(4):417-20. [Medline].