Surgery and Adjuvant Radiation for High-risk Skin Adnexal Carcinoma of the Head and Neck

Abstract

OBJECTIVES Skin adnexal carcinoma (SAC) is a rare cutaneous malignancy that arises from sebaceous and sweat glands. These carcinomas are believed to behave more aggressively than cutaneous squamous cell carcinomas (SCC) with a propensity for local recurrence. The role of adjuvant radiotherapy in SAC is undefined. METHODS We retrospectively reviewed all cases of head and neck SAC treated with surgery and adjuvant radiation from 2000-2012 at a single institution. RESULTS Nine cases were identified. Median age was 67 (range 52-88). The histologies were: adnexal carcinoma (n=1), adnexal carcinoma with sebaceous differentiation (n=1), adnexal carcinoma with squamous differentiation (n=1), skin appendage carcinoma (n=1), sclerosing sweat duct carcinoma (n=1), mucinous carcinoma (n=1), ductal eccrine adenocarcinoma (n=1), porocarcinoma (n=1), and trichilemmal carcinoma (n=1). All tumors were reviewed by a dermatopathologist to confirm the SAC diagnosis. All patients had surgery. Indications for adjuvant radiation included involved lymph nodes (n=4), perineural invasion (n=2), nodal extracapsular extension (n=2), positive margin (n=1), high-grade histology (n=6), multi-focal disease (n=2), and/or recurrent disease (n=5). Radiation was delivered to the primary site alone (n=3), to the draining lymphatics alone (n=2), or to both (n=4). One patient received concurrent cisplatin. Median dose to the primary site was 60Gy and to the neck was 50Gy. Median follow-up was 4.0 years (0.6-11.4 years). Locoregional control was 100%. Five-year progression free survival was 89%. There was one acute grade 3 toxicity and no ≥grade 2 late toxicities were recorded. CONCLUSIONS Surgery and adjuvant radiation for high-risk SAC offers excellent locoregional control with acceptable toxicity.

Squamoid eccrine ductal carcinoma

“…Wang, Handorf, Wu, Liu, Perlis, Galloway et al in a recent review on surgery and adjuvant radiotherapy applied in high risk carcinomas of the head and neck, as in this case, obtained excellent locoregional control with acceptable toxicity. 7 In our case, five months after the end of radiotherapy, the lesion reappeared. Due to the unavailability of surgery with Mohs technique, tumor excision was performed with biopsy by intraoperative frozen section, which revealed free margins, not corroborated by histopathology of the resected product, proving the more aggressive nature of this type of lesion.…”

Identification of potentially druggable molecular alterations in skin adnexal malignancies

“…The mainstay treatment for SAC is radical surgical excision, whereas radiotherapy can be delivered in case of unresectable disease. Postoperative radiation can be considered for high‐risk SAC . In case of recurrent or metastatic (RM) disease, there is no universal consensus regarding systemic treatments.…”

“…Postoperative radiation can be considered for highrisk SAC. 4 In case of recurrent or metastatic (RM) disease, there is no universal consensus regarding systemic treatments. Due to the rarity of such diseases, the availability of published work in this field is very limited, found mainly in case reports or case series.…”

55-Year-Old Woman With Estrogen Receptor–Positive Scalp Lesion

“…This has historically been recommended. 30 Metastatic spread from an alternative primary is less likely given her extensive imaging workup and recent TAH-BSO with negative results. Restaging PET/computed tomography (CT) after surgery was recommended as beneficial to rule out any evidence of recurrence prior to consideration of radiation as adjuvant treatment, given the predicted high risk for local and regional recurrence.…”