Brandon Worley1, Joshua L Owen2, Christopher A Barker3, Ramona Behshad4, Christopher K Bichakjian5, Diana Bolotin6, Jeremy S Bordeaux7, Scott Bradshaw8, Todd V Cartee9, Sunandana Chandra10, Nancy Cho11, Jennifer Choi12, M Laurin Council13, Daniel B Eisen14, Nicholas Golda15, Conway C Huang16, Sherrif F Ibrahim17, S I Brian Jiang18, John Kim19, Mario Lacutoure12, Naomi Lawrence20, Erica H Lee12, Justin J Leitenberger21, Ian A Maher22, Margaret Mann23, Kira Minkis24, Bharat Mittal25, Kishwer S Nehal12, Isaac Neuhaus26, David M Ozog27, Brian Petersen28, Faramarz Samie29, Thuzar M Shin30, Joseph F Sobanko30, Ally-Khan Somani31, William G Stebbins32, J Regan Thomas33, Valencia Thomas34, David Tse35, Abigail Waldman36, Y Gloria Xu37, Siegrid S Yu26, Nathalie C Zeitouni38, Tim Ramsay39, Emily Poon2, Murad Alam2. 1. Division of Dermatology, The Ottawa Hospital, Ottawa, Ontario, Canada. 2. Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. 3. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York. 4. Department of Dermatology, Saint Louis University, St Louis, Missouri. 5. Department of Dermatology, University of Michigan School of Medicine, Ann Arbor. 6. Section of Dermatology, Department of Medicine, The University of Chicago, Chicago, Illinois. 7. Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio. 8. Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada. 9. Department of Dermatology, Pennsylvania State University, Hersey. 10. Division of Oncology, Department of Medicine, Northwestern University Medical Center, Chicago, Illinois. 11. Department of Surgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts. 12. Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York. 13. Center for Dermatologic and Cosmetic Surgery, Division of Dermatology, John T. Milliken Department of Internal Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri. 14. Department of Dermatology, University of California, Davis, Sacramento. 15. Department of Dermatology, University of Missouri School of Medicine, Columbia. 16. Department of Dermatology, The University of Alabama at Birmingham. 17. Department of Dermatology, University of Rochester, Rochester, New York. 18. Department of Dermatology, University of California, San Diego. 19. Department of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. 20. Division of Dermatology, Cooper University Hospital Medical Center, Rowan University, Marlton, New Jersey. 21. Department of Dermatology, Oregon Health & Science University, Portland. 22. Department of Dermatology, University of Minnesota, Minneapolis. 23. Department of Dermatology, University Hospitals, Cleveland, Ohio. 24. Department of Dermatology, Weill Cornell Medicine, Cornell University, New York, New York. 25. Department of Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. 26. Department of Dermatology, University of California, San Francisco. 27. Division of Mohs and Dermatological Surgery, Department of Dermatology and Cosmetic Dermatology, Henry Ford Hospital, Detroit, Michigan. 28. Colorado Permanente Medical Group, Denver. 29. Department of Dermatology, Columbia University Medical Center, New York, New York. 30. Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia. 31. Department of Dermatology, Indiana University School of Medicine, Indianapolis. 32. Division of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee. 33. Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. 34. Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston. 35. Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida. 36. Department of Dermatology, Harvard Medical School, Boston, Massachusetts. 37. Department of Dermatology, University of Wisconsin-Madison, Madison. 38. Department of Dermatology, University of Arizona, Phoenix. 39. Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.
Abstract
IMPORTANCE: Microcystic adnexal carcinoma (MAC) occurs primarily in older adults of white race/ethnicity on sun-exposed skin of the head and neck. There are no formal guiding principles based on expert review of the evidence to assist clinicians in providing the highest-quality care for patients. OBJECTIVE: To develop recommendations for the care of adults with MAC. EVIDENCE REVIEW: A systematic review of the literature (1990 to June 2018) was performed using MEDLINE, Embase, Web of Science, and the Cochrane Library. The keywords searched were microcystic adnexal carcinoma, sclerosing sweat gland carcinoma, sclerosing sweat duct carcinoma, syringomatous carcinoma, malignant syringoma, sweat gland carcinoma with syringomatous features, locally aggressive adnexal carcinoma, and combined adnexal tumor. A multidisciplinary expert committee critically evaluated the literature to create recommendations for clinical practice. Statistical analysis was used to estimate optimal surgical margins. FINDINGS: In total, 55 studies met our inclusion criteria. The mean age of 1968 patients across the studies was 61.8 years; 54.1% were women. Recommendations were generated for diagnosis, treatment, and follow-up of MAC. There are 5 key findings of the expert committee based on the available evidence: (1) A suspect skin lesion requires a deep biopsy that includes subcutis. (2) MAC confined to the skin is best treated by surgery that examines the surrounding and deep edges of the tissue removed (Mohs micrographic surgery or complete circumferential peripheral and deep margin assessment). (3) Radiotherapy can be considered as an adjuvant for MAC at high risk for recurrence, surgically unresectable tumors, or patients who cannot have surgery for medical reasons. (4) Patients should be seen by a physician familiar with MAC every 6 to 12 months for the first 5 years after treatment. Patient education on photoprotection, periodic skin self-examination, postoperative healing, and the possible normal changes in local sensation (eg, initial hyperalgesia) should be considered. (5) There is limited evidence to guide the treatment of metastasis in MAC due to its rarity. Limitations of our findings are that the medical literature on MAC comprises only retrospective reviews and descriptions of individual patients and there are no controlled studies to guide management. CONCLUSIONS AND RELEVANCE: The presented clinical practice guidelines provide an outline for the diagnosis and management of MAC. Future efforts using multi-institutional registries may improve our understanding of the natural history of the disease in patients with lymph node or nerve involvement, the role of radiotherapy, and the treatment of metastatic MAC with drug therapy.
IMPORTANCE: Microcystic adnexal carcinoma (MAC) occurs primarily in older adults of white race/ethnicity on sun-exposed skin of the head and neck. There are no formal guiding principles based on expert review of the evidence to assist clinicians in providing the highest-quality care for patients. OBJECTIVE: To develop recommendations for the care of adults with MAC. EVIDENCE REVIEW: A systematic review of the literature (1990 to June 2018) was performed using MEDLINE, Embase, Web of Science, and the Cochrane Library. The keywords searched were microcystic adnexal carcinoma, sclerosing sweat gland carcinoma, sclerosing sweat duct carcinoma, syringomatous carcinoma, malignant syringoma, sweat gland carcinoma with syringomatous features, locally aggressive adnexal carcinoma, and combined adnexal tumor. A multidisciplinary expert committee critically evaluated the literature to create recommendations for clinical practice. Statistical analysis was used to estimate optimal surgical margins. FINDINGS: In total, 55 studies met our inclusion criteria. The mean age of 1968 patients across the studies was 61.8 years; 54.1% were women. Recommendations were generated for diagnosis, treatment, and follow-up of MAC. There are 5 key findings of the expert committee based on the available evidence: (1) A suspect skin lesion requires a deep biopsy that includes subcutis. (2) MAC confined to the skin is best treated by surgery that examines the surrounding and deep edges of the tissue removed (Mohs micrographic surgery or complete circumferential peripheral and deep margin assessment). (3) Radiotherapy can be considered as an adjuvant for MAC at high risk for recurrence, surgically unresectable tumors, or patients who cannot have surgery for medical reasons. (4) Patients should be seen by a physician familiar with MAC every 6 to 12 months for the first 5 years after treatment. Patient education on photoprotection, periodic skin self-examination, postoperative healing, and the possible normal changes in local sensation (eg, initial hyperalgesia) should be considered. (5) There is limited evidence to guide the treatment of metastasis in MAC due to its rarity. Limitations of our findings are that the medical literature on MAC comprises only retrospective reviews and descriptions of individual patients and there are no controlled studies to guide management. CONCLUSIONS AND RELEVANCE: The presented clinical practice guidelines provide an outline for the diagnosis and management of MAC. Future efforts using multi-institutional registries may improve our understanding of the natural history of the disease in patients with lymph node or nerve involvement, the role of radiotherapy, and the treatment of metastatic MAC with drug therapy.
Authors: Murad Alam; Vishnu Harikumar; Sarah A Ibrahim; Bianca Y Kang; Ian A Maher; Todd V Cartee; Joseph F Sobanko; Nour Kibbi; Joshua L Owen; Kelly A Reynolds; Diana Bolotin; Abigail H Waldman; Kira Minkis; Brian Petersen; M Laurin Council; Kishwer S Nehal; Y Gloria Xu; S Brian Jiang; Ally-Khan Somani; Christopher K Bichakjian; Conway C Huang; Daniel B Eisen; David M Ozog; Erica H Lee; Faramarz H Samie; Isaac M Neuhaus; Jeremy S Bordeaux; Jordan V Wang; Justin J Leitenberger; Margaret W Mann; Naomi Lawrence; Nathalie C Zeitouni; Nicholas Golda; Ramona Behshad; Sherrif F Ibrahim; Siegrid S Yu; Thuzar M Shin; William G Stebbins; Brandon Worley Journal: Arch Dermatol Res Date: 2020-11-18 Impact factor: 3.017
Authors: Iga Płachta; Marcin Kleibert; Anna M Czarnecka; Mateusz Spałek; Anna Szumera-Ciećkiewicz; Piotr Rutkowski Journal: Int J Mol Sci Date: 2021-05-11 Impact factor: 5.923