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However&#44; the lesions had recurred&#44; together with metastatic enlarged inguinal lymph nodes&#59; therefore&#44; she underwent a third procedure with Mohs surgery &#40;free margins&#41; and inguinal lymphadenectomy &#40;metastasis in 6 of 12 nodes isolated&#41;&#46; Furthermore&#44; she had received palliative radiotherapy&#44; as well as various cycles of chemotherapy with docetaxel 75&#8239; mg&#47;m<span class="elsevierStyleSup">2</span>&#44; then with paclitaxel 175&#8239; mg&#47;m<span class="elsevierStyleSup">2</span>&#44; and finally with capecitabine 1250 &#8239;mg&#47;m<span class="elsevierStyleSup">2</span>&#59; the first 2 were suspended owing to lack of efficacy&#44; and the third&#44; which was the most effective&#44; was suspended owing to digestive intolerance&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">After histological confirmation of the new recurrence&#44; the Medical Oncology Department decided to restart capecitabine at 1000 &#8239;mg&#47;m<span class="elsevierStyleSup">2</span>&#46; This was well tolerated and enabled a progression-free interval of only 4 months&#46; The result of massive sequencing of <span class="elsevierStyleItalic">BRAF</span>&#44; epidermal growth factor receptor&#44; and hormone receptors for evaluation of potential therapeutic targets was negative&#46; Therefore&#44; treatment was started with doxorubicin 50&#8239; mg&#47;m<span class="elsevierStyleSup">2</span>&#44; leading to a partial initial response in the skin and lymph nodes&#46; Disease progressed once again after 8 cycles of treatment&#44; with the appearance of skin lesions that extended to the abdomen&#44; vulva&#44; and right thigh&#46; Positron emission tomography-computed tomography revealed lesions in the retroperitoneal and axillary regions&#46; At the time of the last check-up&#44; the patient was receiving treatment in the Palliative Care and Pain Unit&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Eccrine porocarcinoma is an uncommon malignant tumor &#40;0&#46;005&#37;-0&#46;01&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> that originates in the acrosyringium of the eccrine sweat glands&#46; It is more common in elderly persons&#44; with a higher incidence in men&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> and predominantly affects the lower limbs&#44; head&#44; and neck&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a> It usually appears de novo or&#44; in 18&#37; of cases&#44; from an eccrine poroma&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Prognosis is based on histopathology&#46; The differential diagnosis is with squamous cell carcinoma based on immunohistochemical markers&#44; mainly carcinoembryonic antigen &#40;&#43;&#41;&#44; epithelial membrane antigen &#40;&#43;&#41;&#44; and cytokeratin 19 &#40;&#43;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The infiltrative growth pattern and the pagetoid pattern indicate an increased risk of locoregional recurrence&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> as reported in the present case&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The zosteriform or metameric distribution has received little attention&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and the lesions in the case published mimicked those of seborrheic keratosis&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Tumor cells invade the epidermis owing to their epidermotropic character&#44; although they also invade the deep dermis and hypodermis&#44; thus favoring dissemination to the lymphatic system and bloodstream&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> The presence of more than 14 mitoses per field&#44; lymphovascular invasion&#44; and&#47;or tumor thickness&#8239; &#62;&#8239;7 &#8239;mm are associated with a greater risk of metastasis&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The risk of locoregional recurrence is 20&#37;&#44; and this is associated with a mortality rate of 65&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Distant metastasis &#40;lung&#44; bone marrow&#44; bone&#44; and muscle&#41; is less frequent&#44; although in this case mortality is as high as 80&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">G&#243;mez-Zubiaur et al<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> proposed an interesting therapeutic algorithm&#46; If there is a high risk of locoregional recurrence after initial removal of the lesion via conventional surgery&#44; Mohs surgery is recommended&#46; However&#44; if a risk factor for metastasis is present&#44; then it is recommended to perform a selective sentinel node biopsy and then to decide on appropriate action based on the results&#46; Prophylactic lymphadenectomy is controversial&#46; Mohs surgery has only exceptionally proven insufficient for disease control&#44; as previously published<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and as observed in the present case&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Treatment of metastatic disease requires a multidisciplinary approach&#46; Various cycles of chemotherapy based on taxanes and carboplatin combined with epirubicin&#44; docetaxel&#44; or paclitaxel and interferon a have proven relatively successful&#46; Electrochemotherapy is also worthy of evaluation&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Cuenca-Barrales C&#44; Navarro-Trivi&#241;o FJ&#44; Espadafor-L&#243;pez B&#44; Arias-Santiago SA&#44; Ruiz-Vilaverde R&#46; Met&#225;stasis zosteriformes de porocarcinoma ecrino&#46; Actas Dermosifiliogr&#46; 2020&#59;111&#58;276&#8211;278&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#44; Confluent erythematous nodules and papules on the groin and anterior aspect of the left thigh&#46; B&#44; Nodules and ulcerated area &#40;diameter&#44; 4-5 &#8239;cm&#41; with hyperkeratotic borders inside a cicatricial plaque&#46;</p>"
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        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0060" class="elsevierStylePara elsevierViewall">We are grateful to the pathologist Dr&#46; Jos&#233; Aneiros Fern&#225;ndez from Hospital Universitario San Cecilio&#44; Granada&#44; Spain for his contribution to the present case report&#46;</p>"
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Case and Research Letters
Zosteriform Metastases From Eccrine Porocarcinoma
Metástasis zosteriformes de porocarcinoma ecrino
C. Cuenca-Barralesa,
Corresponding author
carloscuenca1991@gmail.com

Corresponding author.
, F.J. Navarro-Triviñoa, B. Espadafor-Lópezb, S.A. Arias-Santiagob, R. Ruiz-Vilaverdea
a Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, Spain
b Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, Spain
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focally&#44; the hypodermis&#44; leaving areas of central necrosis and forming ducts with eccrine differentiation &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#46; Similarly&#44; we observed abundant foci of lymphatic invasion &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41; and numerous areas with epidermotropism &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>C&#41;&#46; The extension study&#44; which was based on positron emission tomography-computed tomography&#44; revealed the presence of hypermetabolic foci and enlarged para-aortic lymph nodes in the left common iliac region and external region and right groin&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Assessment of the previous clinical history revealed that the patient had undergone conventional surgery twice with safety margins of 2 &#8239;cm and surgical margins that were histologically free of neoplasm&#46; However&#44; the lesions had recurred&#44; together with metastatic enlarged inguinal lymph nodes&#59; therefore&#44; she underwent a third procedure with Mohs surgery &#40;free margins&#41; and inguinal lymphadenectomy &#40;metastasis in 6 of 12 nodes isolated&#41;&#46; Furthermore&#44; she had received palliative radiotherapy&#44; as well as various cycles of chemotherapy with docetaxel 75&#8239; mg&#47;m<span class="elsevierStyleSup">2</span>&#44; then with paclitaxel 175&#8239; mg&#47;m<span class="elsevierStyleSup">2</span>&#44; and finally with capecitabine 1250 &#8239;mg&#47;m<span class="elsevierStyleSup">2</span>&#59; the first 2 were suspended owing to lack of efficacy&#44; and the third&#44; which was the most effective&#44; was suspended owing to digestive intolerance&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">After histological confirmation of the new recurrence&#44; the Medical Oncology Department decided to restart capecitabine at 1000 &#8239;mg&#47;m<span class="elsevierStyleSup">2</span>&#46; This was well tolerated and enabled a progression-free interval of only 4 months&#46; The result of massive sequencing of <span class="elsevierStyleItalic">BRAF</span>&#44; epidermal growth factor receptor&#44; and hormone receptors for evaluation of potential therapeutic targets was negative&#46; Therefore&#44; treatment was started with doxorubicin 50&#8239; mg&#47;m<span class="elsevierStyleSup">2</span>&#44; leading to a partial initial response in the skin and lymph nodes&#46; Disease progressed once again after 8 cycles of treatment&#44; with the appearance of skin lesions that extended to the abdomen&#44; vulva&#44; and right thigh&#46; Positron emission tomography-computed tomography revealed lesions in the retroperitoneal and axillary regions&#46; At the time of the last check-up&#44; the patient was receiving treatment in the Palliative Care and Pain Unit&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Eccrine porocarcinoma is an uncommon malignant tumor &#40;0&#46;005&#37;-0&#46;01&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> that originates in the acrosyringium of the eccrine sweat glands&#46; It is more common in elderly persons&#44; with a higher incidence in men&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> and predominantly affects the lower limbs&#44; head&#44; and neck&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a> It usually appears de novo or&#44; in 18&#37; of cases&#44; from an eccrine poroma&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Prognosis is based on histopathology&#46; The differential diagnosis is with squamous cell carcinoma based on immunohistochemical markers&#44; mainly carcinoembryonic antigen &#40;&#43;&#41;&#44; epithelial membrane antigen &#40;&#43;&#41;&#44; and cytokeratin 19 &#40;&#43;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The infiltrative growth pattern and the pagetoid pattern indicate an increased risk of locoregional recurrence&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> as reported in the present case&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The zosteriform or metameric distribution has received little attention&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and the lesions in the case published mimicked those of seborrheic keratosis&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Tumor cells invade the epidermis owing to their epidermotropic character&#44; although they also invade the deep dermis and hypodermis&#44; thus favoring dissemination to the lymphatic system and bloodstream&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> The presence of more than 14 mitoses per field&#44; lymphovascular invasion&#44; and&#47;or tumor thickness&#8239; &#62;&#8239;7 &#8239;mm are associated with a greater risk of metastasis&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The risk of locoregional recurrence is 20&#37;&#44; and this is associated with a mortality rate of 65&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Distant metastasis &#40;lung&#44; bone marrow&#44; bone&#44; and muscle&#41; is less frequent&#44; although in this case mortality is as high as 80&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">G&#243;mez-Zubiaur et al<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> proposed an interesting therapeutic algorithm&#46; If there is a high risk of locoregional recurrence after initial removal of the lesion via conventional surgery&#44; Mohs surgery is recommended&#46; However&#44; if a risk factor for metastasis is present&#44; then it is recommended to perform a selective sentinel node biopsy and then to decide on appropriate action based on the results&#46; Prophylactic lymphadenectomy is controversial&#46; Mohs surgery has only exceptionally proven insufficient for disease control&#44; as previously published<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and as observed in the present case&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Treatment of metastatic disease requires a multidisciplinary approach&#46; Various cycles of chemotherapy based on taxanes and carboplatin combined with epirubicin&#44; docetaxel&#44; or paclitaxel and interferon a have proven relatively successful&#46; Electrochemotherapy is also worthy of evaluation&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0060" class="elsevierStylePara elsevierViewall">We are grateful to the pathologist Dr&#46; Jos&#233; Aneiros Fern&#225;ndez from Hospital Universitario San Cecilio&#44; Granada&#44; Spain for his contribution to the present case report&#46;</p>"
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Article information
ISSN: 15782190
Original language: English
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Idiomas
Actas Dermo-Sifiliográficas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?