Microcystic adnexal carcinoma is a rare adnexal neoplasm that usually develops on the head and neck area, particularly the central face. Clinically Microcystic adnexal carcinoma may present as slow growing, flesh-coloured, firm and indurated plaque or nodule with diffuse, ill-defined margins, sometimes with overlying telangiectasiae. Microcystic adnexal carcinoma can be highly aggressive, leading to substantial local destruction and potential chances of metastasis.
What cause Microcystic adnexal carcinoma?
Long term ultraviolet radiation has been suggested as a predisposing factor for Microcystic adnexal carcinoma as most commonly it occurs in sun exposed sites like face.
Treatment of Microcystic adnexal carcinoma
Despite subsequent widespread recognition of MAC as a discrete clinicopathologic entity, it can easily be confused with other benign adnexal tumors, especially Desmoplastic trichoepithelioma and syringoma [1], often leading to inappropriate initial treatment.
Microcystic adnexal carcinoma has tendency of recurrence if not completely excised. Several treatment approaches has been documented in literatures including radiation therapy, wide excision, and Mohs Micrographic Surgery (MMS). Radiation therapy may be ineffective as the tumor is relatively radioresistant, and most authors agree that surgical excision is probably the most definitive method of treatment [2]. However, even with the wide local excision, the recurrence rates may still be higher.
To avoid the chances of high recurrence, Mohs Micrographic Surgery has been suggested [3]. The author recommends that microcystic adnexal carcinoma managed with Mohs Micrographic Surgery has lower recurrence rate than other alternative wide excision methods supporting the previously published series on Mohs Micrographic Surgery.
References:
1. Goldstein DI, Barr RJ, Santa Crux DJ. Microcystic adnexal carcinoma: a distinct clinicopathological entity. Cancer 1982; 50: 566—72.
2. Mayer MH, Winton GB, Smith AC, Lupton GP, Parry EL, Shagets FW. Microcystic adnexal carcinoma (sclerosing sweat duct carcinoma). Plast Reconstr Surg 1989;84:970-5.
3. Leibovitch I, Huilgol SC, Selva D, Lun K, Richards S, Paver R. Microcystic adnexal carcinoma: treatment with Mohs micrographic surgery. J Am Acad Dermatol. Feb 2005;52(2):295-300
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