Case and Research Letters
Eccrine Carcinoma: The role of Mohs Micrographic Surgery and Review of the Literature
Carcinoma ductal ecrino: papel de la cirugía de Mohs y revisión de la literatura
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Espinosa Lara, C. Bueno Muiño, B. Doger de Spéville, J. Jiménez Reyes" "autores" => array:4 [ 0 => array:2 [ "nombre" => "P. Espinosa" "apellidos" => "Lara" ] 1 => array:2 [ "nombre" => "C. Bueno" "apellidos" => "Muiño" ] 2 => array:2 [ "nombre" => "B. Doger de" "apellidos" => "Spéville" ] 3 => array:2 [ "nombre" => "J. Jiménez" "apellidos" => "Reyes" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731015002823" "doi" => "10.1016/j.ad.2015.03.016" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731015002823?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015003145?idApp=UINPBA000044" "url" => "/15782190/0000010700000001/v2_201704190205/S1578219015003145/v2_201704190205/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Eccrine Carcinoma: The role of Mohs Micrographic Surgery and Review of the Literature" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "73" "paginaFinal" => "76" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Lorente-Luna, E. Jiménez Blázquez, C. Sánchez Herreros, J. Cuevas Santos" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Lorente-Luna" "email" => array:1 [ 0 => "m.lorente.luna@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "E. Jiménez" "apellidos" => "Blázquez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "C. Sánchez" "apellidos" => "Herreros" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J. Cuevas" "apellidos" => "Santos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Central de la Defensa Gómez-Ulla, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de Guadalajara, Guadalajara, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario de Guadalajara, Guadalajara, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Carcinoma ductal ecrino: papel de la cirugía de Mohs y revisión de la literatura" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1446 "Ancho" => 1400 "Tamanyo" => 372174 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Clinical images. A, Design of the rotation flap on the cheek. B, Result immediately after surgery. Rotation flap and Burow graft. C, Lateral view. Result 45 days after surgery. D, Frontal view. Result 45 days after surgery.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Eccrine ductal carcinoma (EDC) is a rare adnexal neoplasm that arises from the eccrine glands. It accounts for 0.01% of all skin tumors.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> The classification of the adnexal tumors is complex and the nomenclature confusing.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Traditionally, adnexal tumors have been considered to present an aggressive behavior.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 37-year-old man who was referred to our department for surgical excision of a well-defined, pink-colored tumor measuring 2.8<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>cm on the left cheek (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). The lesion, which had first appeared 2 years earlier, extended to deeper planes, and was diagnosed as an EDC. Soft-tissue ultrasound, magnetic resonance imaging, and positron emission tomography were performed and showed no deep involvement or distant spread. The excision of the lesion was extended to the muscle plane and a stage of Mohs micrographic surgery was performed for routine processing (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). Histology of the surgical specimen showed an intensely sclerotic epithelial tumor that infiltrated to the muscle (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). Structures with a ductal appearance and areas of squamous differentiation were observed within the tumor (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). Immunohistochemistry was positive for low molecular weight (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>C) and high molecular weight (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>D) cytokeratins and CD10 (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>E), and the cell proliferation index was low (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>F). No tumor nests were detected in the specimen sent for routine study. Surgical reconstruction was performed in a second operation using a rotation flap from the cheek and a Burow graft (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>, A and B), with good cosmetic and functional results (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>, C and D). A year after surgery the patient remains disease free.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">EDC is the most common type of adnexal tumor arising from the eccrine glands<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> and is included in the group of tumors of uncertain behavior.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Because of the small number of cases published, the prognosis remains unknown; the tumor appears to be locally aggressive but with a low probability of metastatic spread. Avraham et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> analyzed more than 200 adnexal tumors with eccrine differentiation, and the majority were found to be in stage <span class="elsevierStyleSmallCaps">i</span>. Clinically, these are slow-growing, erythematous-violaceous tumors that may ulcerate. The clinical and histological differential diagnosis is broad. EDCs are more common in middle-aged and older men and arise preferentially on the scalp, trunk, and limbs.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The clinical differential diagnosis includes basal cell carcinoma, squamous cell carcinoma, skin metastases, cutaneous lymphomas, and amelanotic melanoma. The diagnosis is histological. The architecture of these tumors resembles that of ductal carcinoma of the breast, with nests and cords of cells, a variable degree of glandular differentiation, and infiltration of the adjacent tissues.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> EDCs typically stain positive for carcinoembryonic antigen, epithelial membrane antigen, and cytokeratins 5/6.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Isolated cases with squamous differentiation have been reported<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,5,6</span></a>; the origin of these tumors is controversial and it has been suggested that they may be squamous cell carcinomas arising in the tubules.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> This confusion is probably due to the complexity of their diagnosis, which will have led to underdiagnosis. The histological differential diagnosis includes other adnexal tumors, squamous cell carcinoma in those cases with extensive squamous differentiation, and a possible collision between squamous cell carcinoma and EDC.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Imaging studies for staging have not been standardized, though screening for local invasion and distant spread is recommended. Because EDC is such a rare tumor, it has been included in the TNM staging for squamous cell carcinoma.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Recommended treatment is by surgical excision of the tumor with negative margins, either by radical surgical excision or using Mohs micrographic surgery.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,6</span></a> Although margin width has not been defined,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> margins should be broad because of the tendency to underestimate the size of the tumor.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Margins between 1 and 2<span class="elsevierStyleHsp" style=""></span>cm have been sought in the majority of cases. Mohs micrographic surgery has been used with good results in other adnexal tumors,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> although reports have not specified whether fresh-tissue or fixed-tissue techniques were used. Some authors use 2<span class="elsevierStyleHsp" style=""></span>mm layers of resection,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> others use 5<span class="elsevierStyleHsp" style=""></span>mm,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> and some even support excising an additional layer after obtaining a tumor-free result.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Comparing the 2 techniques, no local recurrences have been detected in the few cases treated by Mohs micrographic surgery, whereas recurrence rates of up to 70% have been reported after wide surgical excision,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> although the follow-up periods have been short. With respect to adjuvant treatment, these tumors have been shown to respond poorly to radiation therapy<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> and chemotherapy. Adjuvant radiation therapy has not been shown to increase survival.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion, EDC is probably a less aggressive tumor than has been thought, but local recurrence is common. The squamous variant appears to be more common than has been reported in the literature and is probably underdiagnosed. In our opinion, Mohs micrographic surgery is a good therapeutic option for EDC, but diagnostic-therapeutic algorithms still need to be developed.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-12-02" "fechaAceptado" => "2015-03-25" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Lorente Luna M, Jiménez Blázquez E, Sánchez Herreros C, Cuevas Santos J. Carcinoma ductal ecrino: papel de la cirugía de Mohs y revisión de la literatura. Actas Dermosifiliogr. 2016;107:73–76.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1063 "Ancho" => 699 "Tamanyo" => 166569 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Clinical image of the lesion on the left cheek. The tumor measures 3<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2.5<span class="elsevierStyleHsp" style=""></span>cm, has a pink surface, and shows signs of extension to deeper planes. B, Clinical image. Surgical excision of the tumor and design of the first stage of Mohs micrographic surgery (5<span class="elsevierStyleHsp" style=""></span>mm).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2081 "Ancho" => 1800 "Tamanyo" => 1071862 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histology. A, Low magnification showing a dense, nonencapsulated infiltrate that reaches the muscle layer. Hematoxylin-eosin (H&E), original magnification ×4. B, Detail of the fibrous stroma, with the presence of glandular lumens and cells grouped in cords. Note the squamous differentiation. H&E, original magnification ×40. C, Immunohistochemistry. Positivity for low molecular weight cytokeratins. Original magnification ×10. D, Immunohistochemistry. Positivity for high molecular weight cytokeratins. Original magnification ×10. E, Immunohistochemistry. Positivity for CD10. Original magnification, ×10. F, Immunohistochemistry. Stain for Ki67. Note the low cell proliferation index. Original magnification, ×10.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1446 "Ancho" => 1400 "Tamanyo" => 372174 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Clinical images. A, Design of the rotation flap on the cheek. B, Result immediately after surgery. Rotation flap and Burow graft. C, Lateral view. Result 45 days after surgery. D, Frontal view. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 11 | 4 | 15 |
| 2024 Octubre | 92 | 45 | 137 |
| 2024 Septiembre | 105 | 34 | 139 |
| 2024 Agosto | 182 | 72 | 254 |
| 2024 Julio | 173 | 37 | 210 |
| 2024 Junio | 118 | 30 | 148 |
| 2024 Mayo | 97 | 29 | 126 |
| 2024 Abril | 111 | 24 | 135 |
| 2024 Marzo | 115 | 22 | 137 |
| 2024 Febrero | 101 | 37 | 138 |
| 2024 Enero | 89 | 28 | 117 |
| 2023 Diciembre | 102 | 23 | 125 |
| 2023 Noviembre | 108 | 33 | 141 |
| 2023 Octubre | 93 | 28 | 121 |
| 2023 Septiembre | 82 | 33 | 115 |
| 2023 Agosto | 65 | 11 | 76 |
| 2023 Julio | 78 | 32 | 110 |
| 2023 Junio | 99 | 19 | 118 |
| 2023 Mayo | 75 | 18 | 93 |
| 2023 Abril | 75 | 23 | 98 |
| 2023 Marzo | 71 | 20 | 91 |
| 2023 Febrero | 69 | 18 | 87 |
| 2023 Enero | 74 | 27 | 101 |
| 2022 Diciembre | 71 | 31 | 102 |
| 2022 Noviembre | 43 | 30 | 73 |
| 2022 Octubre | 25 | 23 | 48 |
| 2022 Septiembre | 37 | 46 | 83 |
| 2022 Agosto | 25 | 41 | 66 |
| 2022 Julio | 31 | 44 | 75 |
| 2022 Junio | 46 | 29 | 75 |
| 2022 Mayo | 32 | 40 | 72 |
| 2022 Abril | 44 | 40 | 84 |
| 2022 Marzo | 48 | 51 | 99 |
| 2022 Febrero | 36 | 34 | 70 |
| 2022 Enero | 33 | 33 | 66 |
| 2021 Diciembre | 38 | 36 | 74 |
| 2021 Noviembre | 37 | 47 | 84 |
| 2021 Octubre | 47 | 53 | 100 |
| 2021 Septiembre | 47 | 47 | 94 |
| 2021 Agosto | 41 | 30 | 71 |
| 2021 Julio | 29 | 33 | 62 |
| 2021 Junio | 32 | 40 | 72 |
| 2021 Mayo | 29 | 34 | 63 |
| 2021 Abril | 55 | 60 | 115 |
| 2021 Marzo | 43 | 18 | 61 |
| 2021 Febrero | 58 | 31 | 89 |
| 2021 Enero | 38 | 18 | 56 |
| 2020 Diciembre | 27 | 20 | 47 |
| 2020 Noviembre | 34 | 28 | 62 |
| 2020 Octubre | 30 | 4 | 34 |
| 2020 Septiembre | 27 | 14 | 41 |
| 2020 Agosto | 15 | 20 | 35 |
| 2020 Julio | 28 | 21 | 49 |
| 2020 Junio | 17 | 30 | 47 |
| 2020 Mayo | 13 | 22 | 35 |
| 2020 Abril | 27 | 20 | 47 |
| 2020 Marzo | 16 | 20 | 36 |
| 2020 Febrero | 3 | 4 | 7 |
| 2020 Enero | 4 | 4 | 8 |
| 2019 Diciembre | 8 | 5 | 13 |
| 2019 Noviembre | 4 | 5 | 9 |
| 2019 Octubre | 0 | 4 | 4 |
| 2019 Septiembre | 4 | 0 | 4 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 0 | 4 |
| 2019 Junio | 4 | 0 | 4 |
| 2019 Mayo | 6 | 0 | 6 |
| 2019 Abril | 2 | 7 | 9 |
| 2019 Marzo | 4 | 3 | 7 |
| 2019 Febrero | 3 | 0 | 3 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Diciembre | 4 | 0 | 4 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 8 | 0 | 8 |
| 2018 Septiembre | 7 | 0 | 7 |
| 2018 Marzo | 2 | 1 | 3 |
| 2018 Febrero | 24 | 1 | 25 |
| 2018 Enero | 27 | 7 | 34 |
| 2017 Diciembre | 34 | 8 | 42 |
| 2017 Noviembre | 19 | 2 | 21 |
| 2017 Octubre | 23 | 8 | 31 |
| 2017 Septiembre | 28 | 5 | 33 |
| 2017 Agosto | 23 | 8 | 31 |
| 2017 Julio | 19 | 14 | 33 |
| 2017 Junio | 18 | 17 | 35 |
| 2017 Mayo | 19 | 10 | 29 |
| 2017 Abril | 22 | 17 | 39 |
| 2017 Marzo | 23 | 30 | 53 |
| 2017 Febrero | 17 | 5 | 22 |
| 2017 Enero | 17 | 4 | 21 |
| 2016 Diciembre | 27 | 8 | 35 |
| 2016 Noviembre | 26 | 15 | 41 |
| 2016 Octubre | 13 | 11 | 24 |
| 2016 Junio | 0 | 3 | 3 |
| 2016 Mayo | 0 | 4 | 4 |
| 2016 Febrero | 0 | 1 | 1 |
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