Mohs Surgery for Periocular Malignancies

Overman, Joe; Leitenberger, Justin J.; White, Kevin P.; Bar, Anna

doi:10.1007/978-3-319-90495-5_80-1

Cited by 1 publication

(3 citation statements)

References 107 publications

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“…71,78 Orbital imaging is not routinely performed, unless there is a concern for orbital invasion. 4,71,78 MRI generally demonstrates an infiltrative poorly defined lesion with low T2 signal intensity, which enhances following administration of gadolinium. 48,53,71,78 CT scan is useful to highlight bone destruction.…”

Section: Discussionmentioning

confidence: 99%

“…64,71 The initial diagnostic biopsy should be large and deep enough to allow visualization of the architecture of the lesion. 4,71,78 Repeat biopsy or re-excision may be required for diagnosis or for clearance of margins to prevent a recurrence. 50,71 Complete excision of the tumor, when possible, is the ultimate therapeutic goal.…”

Section: Managementmentioning

confidence: 99%

“…Microcystic adnexal carcinoma (MAC) is an uncommon locally invasive, low-grade malignant sweat gland tumor of eccrine and pilar origin, first described by Goldstein et al 1 in 1982. Other synonymous terms for MAC to describe the different degrees of sweat ductal/syringomatoid and follicular/trichoepithelial differentiation include “sclerosing sweat duct carcinoma,” “sweat gland carcinoma with syringomatous features,” “syringoid eccrine carcinoma,” “aggressive trichofolliculoma,” “combined adnexal tumor of the skin,” “malignant syringoma,” “eccrine epithelioma,” and “syringomatous carcinoma.” 2–4 MAC has a predilection for facial skin, including the upper lip and nasolabial fold. Periocular skin is less commonly involved.…”

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confidence: 99%

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Periocular Microcystic Adnexal Carcinoma: A Case Report and a Major Review

Cheung

Rabinowitz

Tuluc

et al. 2023

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose: To describe a patient with periocular microcystic adnexal carcinoma (MAC) and to review the clinical presentation, systemic work-up, histopathologic features, and outcome of all previously reported periocular MAC. Methods: A major literature review. PubMed/MEDLINE and Google Scholar databases were searched for all well-documented cases of periocular MAC. Results: The final analysis yielded 93 patients with MAC, 48 (52%) females, 39 (42%) males, and 6 with sex not specified (6%) with an average age of 56 years (range 3 days–95 years). Most tumors were localized to the eyebrow (26/93, 28%) and lower eyelid (20/93, 22%). Of patients with known information, MAC most commonly presented as a nodule (37/68, 54%) or plaque (20/68, 29%) with poorly-defined margins (20/51, 39%) and distortion of eyelid margin (13/51, 25%). Orbital involvement at any point of the disease course was seen in 20 of 93 (22%) patients. An accurate histopathologic diagnosis on initial biopsy was made in 25 of 70 (36%) cases. Initial management included surgical excision (47/93, 51%), Mohs micrographic surgery (17/93, 18%), and excision with frozen section control of margins (8/93, 9%). Aggressive or recurrent MAC was managed with multimodal therapies, including adjuvant radiation (10/34, 29%). The average follow-up after the last treatment was 3 years (median 2, range 0.2–20 years). In total, 33 of 86 (38%) tumors recurred, and 6 of 87 (7%) metastasized. Disease-related mortality occurred in 3 of 79 (4%) of patients. Conclusions: Periocular MAC is frequently misdiagnosed on initial biopsy and has a tendency for recurrence and locally aggressive behavior, highlighting the importance of accurate timely diagnosis, and appropriate management.

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