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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Microcystic adnexal carcinoma &#40;MAC&#41; is a slow-growing&#44; aggressive&#44; cutaneous neoplasm with a tendency for perineural invasion and high recurrence rates&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> There are less than 2000 reported cases worldwide&#44; mostly in Caucasian individuals&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> Although UV exposure&#44; radiotherapy&#44; and genetics may increase susceptibility&#44; the exact pathogenesis remains uncertain&#46; MAC presumably originates from pluripotent adnexal keratinocytes&#44; as it shows elements of eccrine &#40;keratinous cysts&#41; and follicular &#40;epithelial cords and ducts&#41; differentiation&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> It primarily affects the head and neck region&#59; and may appear as an ill-defined&#44; erythematous&#44; skin-coloured&#44; or yellowish plaque&#44; nodule&#44; or cyst&#46; Due to the clinical and histopathological similarity with other skin or adnexal cancers&#44; the disease may be particularly underappreciated in populations that have not been investigated&#46; Therefore&#44; our study aimed to describe the epidemiology and clinical presentation of MAC in Hispanic patients from a tertiary dermatology hospital in Mexico&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We performed a retrospective analysis from 2010 to 2020 including complete patient records with a postoperative&#44; histopathological diagnosis of MAC&#46; A total of 49 cases were found&#44; corresponding to 0&#46;05&#37; of the 83&#44;364 samples reviewed in the dermatopathology department during the study period&#46; The mean age was 67 years &#40;median&#44; 67 years&#59; range&#44; 24&#8211;101 years&#41;&#46; Females &#40;69&#46;4&#37;&#41; were more commonly affected than males &#40;30&#46;6&#37;&#41;&#46; The average time-to-onset was 3 years &#40;median&#44; 2 years&#59; range&#44; 0&#46;08&#8211;22 years&#41;&#46; The head was involved in 91&#46;8&#37; of the cases&#44; and the trunk in 8&#46;2&#37;&#46; In the head region&#44; most lesions occurred on the cheeks &#40;40&#37;&#41;&#44; followed by the nose &#40;28&#46;9&#37;&#41;&#44; lips &#40;11&#46;11&#37;&#41;&#44; forehead &#40;6&#46;7&#37;&#41;&#44; eyelids &#40;6&#46;7&#37;&#41;&#44; scalp &#40;4&#46;4&#37;&#41;&#44; and ears &#40;2&#46;2&#37;&#41;&#46; The nodular aspect &#40;71&#46;4&#37;&#41; predominated over plaque &#40;26&#46;5&#37;&#41; and cyst &#40;2&#37;&#41;&#46; Additional features such as a pearly border&#44; ulceration&#44; atrophy&#44; and telangiectasias were described in 42&#46;9&#37;&#44; 38&#46;8&#37;&#44; 16&#46;3&#37; and 16&#46;3&#37; of the cases&#44; respectively&#46; The average lesion diameter was 1&#46;6<span class="elsevierStyleHsp" style=""></span>cm &#40;median&#44; 1<span class="elsevierStyleHsp" style=""></span>cm&#59; range&#44; 0&#46;3&#8211;10<span class="elsevierStyleHsp" style=""></span>cm&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Apart from the presence of a pearly border&#44; our results are in line with the published literature&#46; In a systematic review of 1968 patients&#44; 92&#46;8&#37; of the subjects were Caucasian&#44; and only 0&#46;2&#37; were Hispanics&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> In total&#44; mean age was 61&#46;8 years&#44; females represented 54&#46;1&#37; of the cases&#44; and latency ranged from 1 to 11 years&#46; Although the location and morphology were not quantitated&#44; it includes other case series where head and neck involvement ranges from 60 to 100&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3&#8211;8</span></a> The mean diameter at diagnosis was 2&#46;8<span class="elsevierStyleHsp" style=""></span>cm&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Since MAC may be confused with other tumours&#44; we also evaluated the clinical and histopathological diagnostic accuracy&#46; Prior to the histopathology result&#44; most were clinically diagnosed as basal cell carcinoma &#40;BCC&#41; &#40;71&#46;4&#37;&#41; and squamous cell carcinoma &#40;SCC&#41; &#40;16&#46;3&#37;&#41;&#44; followed by nevus &#40;4&#46;1&#37;&#41;&#44; lichen planus pilaris &#40;2&#37;&#41;&#44; actinic keratosis &#40;2&#37;&#41;&#44; trichodiscoma &#40;2&#37;&#41;&#44; and adnexal tumour &#40;2&#37;&#41;&#46; As expected&#44; documentation of a pearly border was significantly associated with the presumptive clinical diagnosis &#40;Fisher&#8211;Freeman&#8211;Halton <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;041&#41;&#44; from which BCC represented 90&#46;5&#37; of the cases &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The frequency of preoperative histopathological misdiagnosis was 20&#46;4&#37;&#44; still below the 27&#8211;69&#37; in other case series&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3&#8211;5&#44;9</span></a> In our sample&#44; this included BCC &#40;60&#37;&#41;&#44; basosquamous cancer &#40;20&#37;&#41;&#44; and SCC &#40;20&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The limitations of this study are inherent to its retrospective nature&#46; We were not able to re-evaluate the clinical morphology of the lesions&#44; since descriptions were obtained directly from the medical records&#46; However&#44; these were elaborated by qualified dermatologists from our institution&#46; In the future&#44; we hope to create a picture database to improve our descriptions&#44; and also study various clinical&#8211;histopathological correlations with a focus on prognosis&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion&#44; this is the first study to characterise MAC in Hispanics&#44; specifically of Mexican origin&#46; Our data should complement previous epidemiological and clinical knowledge in a population that has been underrepresented in larger studies&#46; Importantly&#44; our results demonstrate that BCC was the main differential diagnosis of MAC&#44; and that nearly half of our cases had a documented pearly border&#46; Also&#44; our analysis shows that MAC clinical suspicion remains low&#44; with only 1 case &#40;2&#37;&#41; being considered as an adnexal tumour&#46; Moreover&#44; the frequency of histopathological misdiagnosis suggests that initial sampling may be insufficient to establish the definitive diagnosis in more than a fifth of the cases&#46; Therefore&#44; increasing disease awareness is crucial to select an adequate biopsy technique that can improve the diagnostic accuracy of histopathology&#46; Together&#44; this may result in earlier&#44; well-planned treatment strategies and better patient outcomes&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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Case and Research Letter
Epidemiological and Clinical Features of 49 Hispanic Patients With Microcystic Adnexal Carcinoma
Características epidemiológicas y clínicas de 49 pacientes hispanos con carcinoma anexial microquístico
A. Robles-Tenorio
Autor para correspondencia
arturo.rt@tec.mx

Corresponding author.
, V.M. Tarango Martínez
Instituto Dermatologico de Jalisco “Dr. Jose Barba Rubio”, Zapopan, Jalisco, Mexico
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Microcystic adnexal carcinoma &#40;MAC&#41; is a slow-growing&#44; aggressive&#44; cutaneous neoplasm with a tendency for perineural invasion and high recurrence rates&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> There are less than 2000 reported cases worldwide&#44; mostly in Caucasian individuals&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> Although UV exposure&#44; radiotherapy&#44; and genetics may increase susceptibility&#44; the exact pathogenesis remains uncertain&#46; MAC presumably originates from pluripotent adnexal keratinocytes&#44; as it shows elements of eccrine &#40;keratinous cysts&#41; and follicular &#40;epithelial cords and ducts&#41; differentiation&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> It primarily affects the head and neck region&#59; and may appear as an ill-defined&#44; erythematous&#44; skin-coloured&#44; or yellowish plaque&#44; nodule&#44; or cyst&#46; Due to the clinical and histopathological similarity with other skin or adnexal cancers&#44; the disease may be particularly underappreciated in populations that have not been investigated&#46; Therefore&#44; our study aimed to describe the epidemiology and clinical presentation of MAC in Hispanic patients from a tertiary dermatology hospital in Mexico&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We performed a retrospective analysis from 2010 to 2020 including complete patient records with a postoperative&#44; histopathological diagnosis of MAC&#46; A total of 49 cases were found&#44; corresponding to 0&#46;05&#37; of the 83&#44;364 samples reviewed in the dermatopathology department during the study period&#46; The mean age was 67 years &#40;median&#44; 67 years&#59; range&#44; 24&#8211;101 years&#41;&#46; Females &#40;69&#46;4&#37;&#41; were more commonly affected than males &#40;30&#46;6&#37;&#41;&#46; The average time-to-onset was 3 years &#40;median&#44; 2 years&#59; range&#44; 0&#46;08&#8211;22 years&#41;&#46; The head was involved in 91&#46;8&#37; of the cases&#44; and the trunk in 8&#46;2&#37;&#46; In the head region&#44; most lesions occurred on the cheeks &#40;40&#37;&#41;&#44; followed by the nose &#40;28&#46;9&#37;&#41;&#44; lips &#40;11&#46;11&#37;&#41;&#44; forehead &#40;6&#46;7&#37;&#41;&#44; eyelids &#40;6&#46;7&#37;&#41;&#44; scalp &#40;4&#46;4&#37;&#41;&#44; and ears &#40;2&#46;2&#37;&#41;&#46; The nodular aspect &#40;71&#46;4&#37;&#41; predominated over plaque &#40;26&#46;5&#37;&#41; and cyst &#40;2&#37;&#41;&#46; Additional features such as a pearly border&#44; ulceration&#44; atrophy&#44; and telangiectasias were described in 42&#46;9&#37;&#44; 38&#46;8&#37;&#44; 16&#46;3&#37; and 16&#46;3&#37; of the cases&#44; respectively&#46; The average lesion diameter was 1&#46;6<span class="elsevierStyleHsp" style=""></span>cm &#40;median&#44; 1<span class="elsevierStyleHsp" style=""></span>cm&#59; range&#44; 0&#46;3&#8211;10<span class="elsevierStyleHsp" style=""></span>cm&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Apart from the presence of a pearly border&#44; our results are in line with the published literature&#46; In a systematic review of 1968 patients&#44; 92&#46;8&#37; of the subjects were Caucasian&#44; and only 0&#46;2&#37; were Hispanics&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> In total&#44; mean age was 61&#46;8 years&#44; females represented 54&#46;1&#37; of the cases&#44; and latency ranged from 1 to 11 years&#46; Although the location and morphology were not quantitated&#44; it includes other case series where head and neck involvement ranges from 60 to 100&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3&#8211;8</span></a> The mean diameter at diagnosis was 2&#46;8<span class="elsevierStyleHsp" style=""></span>cm&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Since MAC may be confused with other tumours&#44; we also evaluated the clinical and histopathological diagnostic accuracy&#46; Prior to the histopathology result&#44; most were clinically diagnosed as basal cell carcinoma &#40;BCC&#41; &#40;71&#46;4&#37;&#41; and squamous cell carcinoma &#40;SCC&#41; &#40;16&#46;3&#37;&#41;&#44; followed by nevus &#40;4&#46;1&#37;&#41;&#44; lichen planus pilaris &#40;2&#37;&#41;&#44; actinic keratosis &#40;2&#37;&#41;&#44; trichodiscoma &#40;2&#37;&#41;&#44; and adnexal tumour &#40;2&#37;&#41;&#46; As expected&#44; documentation of a pearly border was significantly associated with the presumptive clinical diagnosis &#40;Fisher&#8211;Freeman&#8211;Halton <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;041&#41;&#44; from which BCC represented 90&#46;5&#37; of the cases &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The frequency of preoperative histopathological misdiagnosis was 20&#46;4&#37;&#44; still below the 27&#8211;69&#37; in other case series&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3&#8211;5&#44;9</span></a> In our sample&#44; this included BCC &#40;60&#37;&#41;&#44; basosquamous cancer &#40;20&#37;&#41;&#44; and SCC &#40;20&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The limitations of this study are inherent to its retrospective nature&#46; We were not able to re-evaluate the clinical morphology of the lesions&#44; since descriptions were obtained directly from the medical records&#46; However&#44; these were elaborated by qualified dermatologists from our institution&#46; In the future&#44; we hope to create a picture database to improve our descriptions&#44; and also study various clinical&#8211;histopathological correlations with a focus on prognosis&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion&#44; this is the first study to characterise MAC in Hispanics&#44; specifically of Mexican origin&#46; Our data should complement previous epidemiological and clinical knowledge in a population that has been underrepresented in larger studies&#46; Importantly&#44; our results demonstrate that BCC was the main differential diagnosis of MAC&#44; and that nearly half of our cases had a documented pearly border&#46; Also&#44; our analysis shows that MAC clinical suspicion remains low&#44; with only 1 case &#40;2&#37;&#41; being considered as an adnexal tumour&#46; Moreover&#44; the frequency of histopathological misdiagnosis suggests that initial sampling may be insufficient to establish the definitive diagnosis in more than a fifth of the cases&#46; Therefore&#44; increasing disease awareness is crucial to select an adequate biopsy technique that can improve the diagnostic accuracy of histopathology&#46; Together&#44; this may result in earlier&#44; well-planned treatment strategies and better patient outcomes&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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