Mohs Micrographic Surgery, Sentinel Lymph Node Mapping, and Estrogen Receptor Analysis for the Treatment of Malignant Nodular Hidradenoma

Abstract

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]

Mohs Micrographic Surgery for the Treatment of Hidradenocarcinoma

“…14,[21][22][23][24][25] In this series, the head and neck was the most commonly affected site (60%), with the occipital scalp and cheeks being affected in 40% and 20%, respectively. 4,5,9,17,[29][30][31][32][33] Although new advances in medical therapeutic options for metastatic disease are being investigated, [34][35][36] surgical therapy should still be attempted in metastatic HAC. 8,15,19 Currently, the standard of care for definitive treatment of a variety of nonmelanoma skin cancers, [26][27][28] MMS is increasingly reported for the treatment of adnexal tumors.…”

“…The cases currently available in publication demonstrate efficacy in tumor clearance, and in light of tissue preservation permitted by MMS, increased repair options and decreased morbidity are expected. 4,5,9,[30][31][32] The authors sought to build on this body of literature by reviewing the institution's 2-decade experience using MMS exclusively in the treatment of HAC. 37 The rarity of HAC has made it difficult to fully characterize its behavior and identify optimal treatment approaches.…”

Malignant nodular hidradenoma of the skin: report of seven cases

“…More recently, 3‐ to 5‐cm‐wide local excision has been recommended 26 . Mohs micrographic surgery has also been proposed to help identify subtle extensions of irregular dermal tumours 3,14,25–29 . As suggested by Wong et al.…”

“…However, 3 of 7 of our cases had primitive lesions in the head and neck region, where surgery is more problematical than in other parts of the body. Because of the aggressive nature of MNH and its spread through regional lymphatics, many authors advocate prophylactic lymph node dissection, especially for large, recurrent or anaplastic tumours 14,26,27 . Oestrogen receptor analysis has also been recommended for the treatment of MNH 8,24,27 patients with positive tests may also undergo hormonal therapy 17,22 .…”

Current Progress of Immunostains in Mohs Micrographic Surgery: A Review

“…3 Bhardwaj and colleagues describe the use of Mel-5 immunostaining adding 40 minutes to each stage when performed manually and 20 minutes when using an Autostainer immunostaining system (Dako). 114 ( 1 ) stain = CD10 (À) stain = S100, CD34 Malignant nodular hidradenoma 117,118 ( 1 ) stains = estrogen receptor, cytokeratin, EMA, CEA (À) stain = progesterone receptor Sebaceous carcinoma…”