Periocular Microcystic Adnexal Carcinoma: Management and Outcome with Mohs’ Micrographic Surgery

Abstract

Purpose: To report a series of patients with periocular microcystic adnexal carcinoma (MAC) treated with Mohs’ micrographic surgery (MMS). Design: Prospective, interventional case series. Methods: This series included all patients treated with MMS for periocular MAC, who were monitored by the Skin and Cancer Foundation Australia between 1993 and 2002. Results: There were 5 patients (4 males, 1 female) with a mean age of 52 ± 12 years. Four tumors were located in the medial canthus and one in the lower lid.The tumor was initially misdiagnosed as basal cell carcinoma in 3 patients and squamous cell carcinoma in 1 patient. The average number of excision levels required for complete removal of the tumor during MMS was 2.2 (range 1–6). Perineural invasion was recorded in one patient.Five-year follow-up data was available for 3 patients, and there was no tumor recurrence in any of these cases. Conclusion: The low 5-year recurrence rate of periocular MAC with MMS emphasizes the importance of margin-controlled excision of this tumor.

Periocular Cutaneous Malignancies: A Review of the Literature

“…188,189 Treatment consists of wide local excision and adjuvant radiation and chemotherapy. 190 Four of the tumors were initially misdiag-nosed as BCC or SCC, one of the cases had PNI, and all were successfully treated with MMS without recurrence at 5-year follow-up. 190 Four of the tumors were initially misdiag-nosed as BCC or SCC, one of the cases had PNI, and all were successfully treated with MMS without recurrence at 5-year follow-up.…”

“…188,189 Periocular microcystic adnexal carcinoma (MAC) was described in a case series of five patients: four with medial canthal lesions and one on the lower lid. 190 A review of 25 cases found MMS to be the most-effective treatment for MAC. 190 A review of 25 cases found MMS to be the most-effective treatment for MAC.…”

Treatments for microcystic adnexal carcinoma – A review

“…Patients treated with MMS did not require further treatments (4) (5) . MMS patients also had defects four times larger than clinically evident tumors (4) (6) (7,8) . Those treated with WLE had positive margins and required at least one additional surgical procedure as a result of a positive surgical margin (4,5) .…”

“…Thomas et al (6) found tumors were more likely to recur after MMS if their initial presentation was recurrent rather than primary. Recurrent tumors referred for MMS required a greater number of stages to clear and were more likely to have perineural invasion (PNI) (7,8) .…”

Management and Reconstruction of Periocular Malignancies

“…2 In 2006, Leibovitch and group showed a series of patients with squamous cell carcinoma who had 0% recurrence over 5 years. 5 Conventional techniques for treating squamous cell carcinoma result in 3 to 23% recurrence over 5 years.…”