Immediate Umbilical Reconstruction after a Mohs Micrographic Surgery for Primary Cutaneous Adenoid Cystic Carcinoma Arising in the Umbilicus

Adenoid cystic carcinoma (ACC) is a malignant neoplasm of glands commonly occurs in salivary glands. Primary cutaneous adenoid cystic carcinoma (PCACC) is a rare form of ACC that primarily presents on the skin. Herein, we represent a rare case of PCACC occurred in the umbilicus in a 66-year-old Korean male patient. The patient visited our center with erythematous indurated patch on the umbilicus diagnosed as ACC by incisional biopsy at another center. The diagnosis of PCACC was confirmed by additional histopathologic examination and imaging study. We proceeded Mohs micrographic surgery and reconstructed umbilicus with tacked purse string suture. Local recurrence and distant metastasis were not observed during 30-month follow-up. We report this rare case of PCACC on the umbilicus so that dermatologist can aware of the rare disease. Furthermore, we recommend MMS and tacked purse string suture as effective methods for treatment of PCACC and immediate umbilical reconstruction.

Immediate Umbilical Reconstruction for Urachal Cancer

The umbilicus is a central line of abdomen and can be an important aesthetic interest in the abdomen wall, so its loss can be a source of psychological distress. Many techniques for reconstruction of a lost umbilicus have been described, however none has achieved a perfect result. There are few reports that describe the procedure for immediate reconstruction of umbilicus after surgical ablation except Miller's Iris technique. We have performed umbilical reconstruction right after the umbilicus was resected during the surgery. The patient was a 34 year old man with urachal cancer, who wanted to have his lost umbilicus reconstructed immediately for personal, social, and aesthetic reasons. We tried immediate reconstruction with modified iris technique. Using three local flaps, we fixed the central portion of inferior flap at the area of 1 cm below umbilical defect on linea alba. The neoumbilicus retained in its depth and natural shape. This technique is considered to be simple and draw good results.