ABSTRACT
Eccrine porocarcinoma, sharing many features with other skin tumours, is diagnostically challenging. A conventional biopsy might be misleading and surgical excision becomes a primary diagnostic tool and a treatment method. However, the data on surgical safety margins are not consistent. We present a systematic review analysing the surgical margins of porocarcinoma in the head and neck area, which was conducted across the PubMed, Cochrane, and Web of Science databases including studies published from inception to November of 2023. In this systematic review, the PRISMA-ScR checklist was used, and a Cohen's Kappa coefficient of 0.92 was applied, indicating very good agreement between reviewers. Out of 529 identified articles, 18 studies yielding 20 cases in total were selected for a thorough analysis. Nine (45%) cases were observed in the facial regions, eight (40%) on the scalp, and three (5%) on the neck. The primary treatment of choice was wide local excision with safety margins ranging from 3 to 22 mm (mean: 10.1). It demonstrated that surgical margins do not differ by age or anatomic regions, with the main point of reference being the tumour size. As observed, the bigger the tumour, the wider the safety margins were. However, the limited disclosure of surgical safety margins in analysed case reports impeded our ability to define the minimum safety margins. Further investigation and a consensus on recommended safety margins are required.
ABSTRACT
Psoriasis is a common chronical inflammatory skin disease with a prevalence of 2%-4% worldwide. In contrast, porocarcinoma is a relatively rare cutaneous neoplasm and an associated localization of both lesions is rare. Here, we describe the first case of porocarcinoma in a patient with psoriasis. A 71-year-old Japanese man was referred to our clinic for evaluation of nodule within a keratotic plaque of 20-years history on his leg. Histopathological examination showed that the plaque revealed acanthosis with regular elongation of rete ridges, agranulosis and the presence of Munro microabscesses. In contrast, massive proliferation of atypical poroid cells and a few cuticular cells in the dermis were seen in the nodule. We speculated that it is likely the porocarcinoma was caused by the elevated risk of skin cancer due to chronic inflammatory process of psoriasis itself in our patient.
ABSTRACT
Eccrine porocarcinoma (EPC) is a rare malignancy of the sweat glands. Currently, there is no standard algorithm for its presentations, diagnosis, and management. However, immunotherapy is an emerging option that may be crucial to the treatment of EPC. This report presents a case of a 79-year-old male who had a skin biopsy of an anterior scalp lesion, which revealed EPC. The patient underwent Mohs micrographic surgery to excise the tumor followed by two additional Mohs surgeries for recurrence and adjuvant radiotherapy. A follow-up positron emission tomography (PET) scan revealed yet another recurrence at the scalp as well as metastases to the left parotid gland and left submandibular lymph node. The patient was started on immunotherapy with pembrolizumab, a programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitor, and later achieved remission. This report demonstrates the effective management of EPC using immunotherapy with pembrolizumab.
ABSTRACT
BACKGROUND: The aim of the study is to analyze potential prognostic factors and to evaluate therapy strategies regarding clinical outcome in patients with eccrine porocarcinoma (EPC) of the head and neck. METHODS: One hundred and sixteen EPC cases from ninety studies and four authors' EPC cases were included in the meta-analysis. RESULTS: At an average follow up of 20.48 months, the 3-year overall survival and regional recurrence rate were 70.3% and 19.0%, respectively. Patients without surgical treatment had a significantly worse 3-year overall survival. Mohs microscopic surgery led to significantly less occurrence of regional recurrences compared to wide excision. An ulcerating lesion, high mitotic activity, and lymphovascular invasion were significant prognostic factors. CONCLUSION: Surgical resection is the cornerstone in the therapy of EPC and represents the therapeutic modality that offers the best chance of disease-free survival. Due to the high probability of recurrence, close follow-ups are strongly recommended.
Subject(s)
Eccrine Porocarcinoma , Sweat Gland Neoplasms , Eccrine Porocarcinoma/surgery , Head , Humans , Mohs Surgery , Neoplasm Recurrence, Local , Sweat Gland Neoplasms/surgeryABSTRACT
BACKGROUND: Eccrine porocarcinoma (EPC) is a rare malignant cutaneous adnexal tumor. Other than several scattered case reports, no comprehensive review on EPC has been conducted in Korea. OBJECTIVE: To clinicopathologically review all EPC cases from our institutions as well as those reported in Korea. METHODS: Medical records and histopathological slides of EPC cases in the skin biopsy registries of our institutions were retrospectively reviewed. Additionally, EPC cases reported in Korea before June 2019 were retrieved by searching the PubMed, KoMCI, KoreaMed, and KMbase databases. RESULTS: Nine EPC cases from our institutions were included in the study. In addition, 27 reports of 28 patients with EPC were reported in Korea. A total of 37 patients with EPC were identified, consisting of 19 males (male:female ratio, 1.06:1; mean age at diagnosis, 65.6 years). The most common site of primary tumor was the head and neck (29.7%). Wide excision was the most common (78.4%) treatment method. Initial metastasis work-up imaging studies were performed in 18 patients (48.6%), and metastasis was confirmed in eight patients (21.6%). CONCLUSION: EPC is a rare cutaneous carcinoma in Korea. EPC usually affects elderly patients, with no sexual predilection. Due to possible metastasis, careful diagnosis and appropriate metastasis work-ups are warranted in EPC.
ABSTRACT
OBJECTIVES: Malignant eccrine poroma is a rare cutaneous malignancy. This study was a review of a series of patients with malignant eccrine poroma who underwent surgical treatment conducted in order to evaluate the management techniques and outcomes of treatment modalities. METHODS: All cases of surgically excised malignant eccrine poroma performed in a single clinic between 2012 and 2018 were included in the study. The details of patient age, gender, anatomical location of the tumor, histopathological features, and treatment modalities were analyzed. RESULTS: The average tumor size was 2.53 cm (range: 0.3-7 cm). The average tumor thickness was 3.06 mm (range: 2.5-4 mm). The mean clean tumor margin after the first excision was 1.28 mm and the mean tumor margin after the second excision was 8.83 mm. No recurrence or distant metastasis was detected in any of the patients during the follow-up period. CONCLUSION: Unlike frequent skin cancers, rare skin cancers, like malignant eccrine poroma, don't have definite treatment algorithms constituted from randomized trials. The findings of patient series are very useful to guide physicians in these cases.
ABSTRACT
The successful treatment of the rare malignancy eccrine porocarcinoma (EP) is extremely challenging, often not rewarding and when associated with metastatic disease, therapy results are disappointing. We present a unique case of treatment response of metastatic EP, with a significant disease-free interval. The patient has remained in clinical and radiological remission for 36 months since diagnosis of metastatic disease.
ABSTRACT
Malignant eccrine poroma is a rare malignancy of the eccrine sweat glands, occurring most frequently on the lower extremities. It affects both sexes equally usually in the 6(th) to 7(th) decade of life. Metastasis to regional lymph nodes may occur in 20% that may be fatal in 60% cases. Its aggressive nature, rarity of occurrence, and unusual presentations make it very important to be evaluated properly by the clinician. We hereby report a case of a 75-year-old female presenting with two exophytic tumors over her vulva with local extension. On histopathological examination, it was diagnosed as malignant eccrine poroma. On magnetic resonance imaging of the pelvic region, metastatic extension in regional lymph nodes was found. She was treated by radical vulvectomy with bilateral inguinal and femoral lymph node dissection followed by radiotherapy.
ABSTRACT
Eccrine porocarcinoma (EP) is a rare malignant tumor arising from the intraepidermal eccrine duct. The tumor cells frequently contain glycogen, but prominent clear cell changes in EP are rarely reported. A 78-year-old woman presented with a slightly pruritic, erythematous, verrucous plaque on her left thigh. Histopathological examination revealed intraepidermal tumor cell nests composed of small basaloid cells and duct-like structures lined by periodic acid-Schiff (PAS)-positive cuticles. Besides the typical findings of EP, clear cell changes were predominantly observed in the tumor cell aggregations. Herein we report a case of the clear cell variant of EP rarely reported in previous literature.
ABSTRACT
Eccrine porocarcinoma (EP) is a rare malignant tumor arising from the intraepidermal eccrine duct. The tumor cells frequently contain glycogen, but prominent clear cell changes in EP are rarely reported. A 78-year-old woman presented with a slightly pruritic, erythematous, verrucous plaque on her left thigh. Histopathological examination revealed intraepidermal tumor cell nests composed of small basaloid cells and duct-like structures lined by periodic acid-Schiff (PAS)-positive cuticles. Besides the typical findings of EP, clear cell changes were predominantly observed in the tumor cell aggregations. Herein we report a case of the clear cell variant of EP rarely reported in previous literature.
Subject(s)
Aged , Female , Humans , Cell Aggregation , Eccrine Porocarcinoma , Glycogen , ThighABSTRACT
Malignant eccrine poroma is a rare skin appendageal tumor arising from the intraepidermal ductal portion of the eccrine sweat gland. It may develop either spontaneously or from a long-standing eccrine poroma. It usually affects the aged and is located most commonly on lower extremities. We report a case of malignant eccrine poroma occurring on the suprapubic area of a 75-year-old Korean man. He underwent wide excision and flap coverage.
ABSTRACT
Malignant eccrine poroma is a rare skin appendageal tumor arising from the intraepidermal ductal portion of the eccrine sweat gland. It may develop either spontaneously or from a long-standing eccrine poroma. It usually affects the aged and is located most commonly on lower extremities. We report a case of malignant eccrine poroma occurring on the suprapubic area of a 75-year-old Korean man. He underwent wide excision and flap coverage.
Subject(s)
Aged , Humans , Eccrine Porocarcinoma , Lower Extremity , Poroma , Skin , Sweat GlandsABSTRACT
Malignant eccrine poroma is a rare skin appendage tumor, originating from the intraepidermal eccrine duct. It develops either spontaneously or in an eccrine poroma of long-standing duration. It usually affects older people and is located most commonly on the lower extremities. We report a case of an 84 year old woman with a malignant eccrine poroma on the left upper eyelid, which resembled a cutaneous horn. She presented with a solitary, tender, firm, 0.4x0.4x0.9 cm-sized, silvery-white colored papule on the left upper eyelid. She was treated with surgical excision and to date shows no recurrence.
Subject(s)
Aged, 80 and over , Animals , Female , Humans , Eccrine Porocarcinoma , Eyelids , Horns , Lower Extremity , Poroma , Recurrence , SkinABSTRACT
Malignant eccrine poroma is a rare malignant tumor that arises from the intraepithelial ductal portion of the eccrine sweat gland. It may be developed either spontaneously or from a preexisting benign eccrine poroma. We report a case of malignant eccrine poroma on right lower abdomen in a 78-years-old female, which has been present for 1 year. In our case the tumor demonstrated without local invasion and distant metastasis, and was successfully removed by surgery.
Subject(s)
Female , Humans , Abdomen , Eccrine Porocarcinoma , Neoplasm Metastasis , Poroma , Sweat GlandsABSTRACT
Malignant eccrine poroma is a rare malignant cutaneous tumor arising from intraepithelial eccrine duct and it may develop either spontaneously or from a long standing eccrine poroma. We report a case of malignant eccrine poroma on the antihelix of the right ear in a 37-year-old female, previously diagnosed as a benign eccrine poroma with shave biopsy specimens. Histological findings are well-defined tumor cell nests disseminated in dermis. Each cell has a large, hyperchromatic atypical nuclus. The atypical mitoses, dyskeratoses, intracytoplasmic vacuolations and duct-like structures are observed. She was treated with wide surgical excision and local skin flaps.
Subject(s)
Adult , Female , Humans , Biopsy , Dermis , Ear , Eccrine Porocarcinoma , Mitosis , Poroma , SkinABSTRACT
Malinant eccrine poroma is a rare malignant tumor that arises from the intraepithelial ductal portion of the eccrine sweat gland, that may develop either spontaneously or from a preexisting benign eccrine poroma. It usually affects elderly patients in both sexes and is usually found on the lower extremities and the head. We described 71-year-old female with a malignant eccrine poroma in the scalp developing from benign eccrine poroma, which has been present for 5 years. The local recurrence and regional metastatic rate are both approximately 20%. Distant metastasis occurs in 12% of cases. In our case the tumor demonstrated without local invasion and distant metastasis, and was successfully removed by surgery.
Subject(s)
Aged , Female , Humans , Eccrine Porocarcinoma , Head , Lower Extremity , Neoplasm Metastasis , Poroma , Recurrence , Scalp , Sweat GlandsABSTRACT
Malignant eccrine poroma, or eccrine porocarcinoma, is a rare malignant cutaneous appendageal tumor arising from the intraepidermal eccrine sweat duct(acrosyringium), and usually develops ia an eccrine poroma of long-standing. We report a case of malignant eccrine poroma on the left buttock in a 72 year-old female. She was presented with a slightly pruritic, well-defined, reddish, firm, 4.5 x 4.5 x 0.7cm sized, protruding, ulcerated tumor. Histopathological examination revealed well-defined tumor cell nests in the epidermis and dermis. The tumor nests consisted of areas of eccrine poroma cells with benign appearance adjoining areas of anaplastic cells. Duct-like structures were observed within the tumor nests and showed a PAS-positive, diastase-resistant reaction. On immunohistochemical staining, the tumor cells were, positive for EMA, and most of tumor cells were negative but the duct-like structures were positive for CEA. She was treated with surgical excision. During the three year follow up period after excision, there was no recurrence.
Subject(s)
Aged , Female , Humans , Buttocks , Dermis , Eccrine Porocarcinoma , Epidermis , Follow-Up Studies , Poroma , Recurrence , Sweat , UlcerABSTRACT
Eccrine porocarcinoma is a rare tumor of the skin. A case report of an eccrine porocarcinoma metastasizing to epidural space of spinal cord and inguinal area with a nine year follow up is described. The patient had a nodular growth of the abdomen with both inguinal lymphadenopathy three years before its first excision. After a follow up of nine years, he complained a weakness of lower extremities and back pain. Extradural mass of 10th thoracic vertebra and left inguinal mass were found. Subsequently, the masses histologically identical to the skin tumor were found.
