The authors have indicated no significant interest with commercial supporters.M alignant nodular hidradenoma (MNH) is a rare sweat gland carcinoma that has been reported under numerous synonyms: malignant acrospiroma, malignant clear cell acrospiroma, malignant clear cell myoepithelioma, malignant clear cell hidradenoma, clear cell hidradenocarcinoma, solid-cystic hidradenocarcinoma, and clear cell eccrine carcinoma. This tumor has a propensity for aggressive behavior; local recurrence and distant metastases occur in as many as 50% to 60% of patients. The 5-year postsurgical survival rate for MNH is reportedly less than 30%. 1 MNH tends to present as indistinct, occasionally ulcerated, erythematous to violaceous firm nodules, frequently with a history of recent growth. 2 Microscopically, the cellular features and tumor architecture do not correlate well with the clinical course and often contradict their aggressive behavior. Several histologic banal-appearing tumors, some initially interpreted as benign nodular hidradenoma, have been seen to later metastasize. [3][4][5]