Microcystic Adnexal Carcinoma Follow-up

  • Author: Nektarios I Lountzis, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jul 28, 2010
 

Further Outpatient Care

The longest latent period for microcystic adnexal carcinoma (MAC) recurrence following simple excision is 30 years. This particular patient underwent a simple excision for adnexal adenoma in 1953. When he presented again 30 years later, the initial slides were reviewed, and a retrospective diagnosis of microcystic adnexal carcinoma was made. This case illustrates the indolent nature of microcystic adnexal carcinoma and supports the view that simple excision may be not adequate and long-term follow-up care is required.

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Deterrence/Prevention

Sun avoidance minimizes UV exposure, which may be a predisposing factor.

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Complications

Local recurrence is a complication if it is not properly excised. Additionally, because of the deep penetration of the tumor, destruction of underlying tissue (eg, bone, cartilage, muscle) can lead to structural changes and increased morbidity.

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Prognosis

Overall, the prognosis is good, especially when margin-control techniques such as Mohs micrographic surgery (MMS) are used, with a modest tendency for recurrence and a very low rate of metastases.

The largest series of cases reports an overall (combining results from simple excision and MMS) 10-year recurrence rate of 18%. Others have reported a 12% recurrence rate at mean follow-up of 39 months.[5]

Although microcystic adnexal carcinoma is considered a nonmetastasizing tumor, rare reports detail histologically confirmed lymphatic spread. Of the more than 300 reported cases of microcystic adnexal carcinoma, only 9 have been metastatic.[6, 7, 8, 9, 10, 11, 12, 13, 14]

Two deaths have been attributed to metastatic microcystic adnexal carcinoma. One patient presented with mediastinal lymphadenopathy and later died of the disease. However, no histologic evidence from the lymph nodes confirmed the cause of death.[12] The other death occurred from a microcystic adnexal carcinoma of the right-upper eyebrow that lead to perineural spread though the orbit with central nervous system dissemination.[11] In another reported case of distant metastatic disease, the patient eventually died of aspiration pneumonia, not from the microcystic adnexal carcinoma itself.[13]

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Contributor Information and Disclosures
Author

Nektarios I Lountzis, MD  Consulting Staff, Departments of Dermatology and Pathology, Geisinger Wyoming Valley Medical Center

Nektarios I Lountzis, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Mary Grace Petrick, MD  Consulting Staff, Department of Dermatology, Geisinger Medical Center

Mary Grace Petrick, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, and American Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

Bruce C Gee, MB, BCh, MRCP  Specialist Registrar, Department of Dermatology, Queen's Medical Centre, Nottingham, UK

Bruce C Gee, MB, BCh, MRCP is a member of the following medical societies: Royal College of Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Kelly M Cordoro, MD  Assistant Professor of Pediatric and Adult Dermatology, Department of Dermatology, University of California, San Francisco School of Medicine

Kelly M Cordoro, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Association of Professors of Dermatology, Dermatology Foundation, Medical Society of Virginia, National Psoriasis Foundation, Society for Pediatric Dermatology, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

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

Disclosure: Nothing to disclose.

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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Clinical photo of a microcystic adnexal carcinoma on the left upper lip of an elderly woman. Note the close clinical resemblance to basal cell carcinoma. Courtesy of Dirk M. Elston, MD.
A low-power view of microcystic adnexal carcinoma demonstrates superficially located keratocysts and variably sized tumor nests and ducts. Note the diminution in size of the nests and cysts with the depth of dermal invasion. Courtesy of Dirk M. Elston, MD
Small ductular structures lined by 2-3 cell layers of small eosinophilic cells showing little pleomorphism set in a dense fibrous stroma. Courtesy of Dirk M. Elston, MD.
A high-power view of small, irregularly shaped nests and strands of small tumor cells without obvious ductal formation. Courtesy of Dirk M. Elston, MD.
 
 
 
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