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Microcystic Adnexal Carcinoma-- Mohs Surgery vs. Simple Excision
Microcystic adnexal carcinoma is a relatively rare skin cancer that is often invasive and extensive and that is frequently accompanied by perineural invasion. These authors retrospectively compared the management and outcome of 48 patients with microcystic adnexal carcinoma treated at 1 institution, some by Mohs surgery and some by simple excision.
Thirty-three physicians in 5 specialties -- dermatology, otolaryngology, gynecology, ophthalmology, and plastic surgery -- managed the cases. The initial biopsy had been misdiagnosed in 27 percent of cases. Three patients had had no further procedure after the initial biopsy and 22 patients had had successful further treatment by Mohs surgery. In the Mohs patients, the final defect surface area was, on average, 4 times the size of the clinically apparent area, demonstrating the large extent of subclinical tumor spread. Twenty-three patients had been treated by simple excision; 7 of these required at least 1 more procedure. Of these, 2 needed a third procedure, 1 a fourth, and 1 still had tumor after 4 procedures. After a mean follow-up period of 3.2 years, 2 Mohs patients had developed recurrences, as had 1 excision patient. The difference in recurrence rates was not significant.
Comment: While Mohs surgery did not achieve a higher cure rate than conventional serial excision, it achieved tumor clearance in 1 surgical session, sparing many patients the need for multiple sessions. Microcystic adnexal carcinoma is a slow-growing tumor; long-term follow-up of 5 to 10 years will be needed to determine whether Mohs surgery provides a cure rate advantage over conventional serial excision. The high number of initial misdiagnoses supports a recommendation that skin biopsies be interpreted by experienced dermatopathologists.
— GJ Hruza
Published in Journal Watch Dermatology November 22, 2000
Citation(s):
Chiller K et al. Microcystic adnexal carcinoma: forty-eight cases, their treatment, and their outcome. Arch Dermatol 2000 Nov 136
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