Malignant Cutaneous Adnexal Tumors and Role of SLNB : Journal of the American College of Surgeons (original) (raw)
New England surgical society article
Storino, Alessandra MDa; Drews, Reed E. MDb; Tawa, Nicholas E. Jr. MD, PhD, FACSa,*
aDivision of Surgical Oncology, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
bDivision of Hematology-Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
email: [email protected]
Received November 22, 2020; Revised and Accepted January 11, 2021.
Disclosure Information: Nothing to disclose.
Poster presented virtually at the 101st Annual Meeting of the New England Surgical Society, October 2020; oral presented virtually at the American College of Surgeons 106th Annual Clinical Congress, October 2020.
*Correspondence address: Nicholas E Tawa Jr, MD, PhD, FACS, Division of Surgical Oncology, Department of Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215.
Journal of the American College of Surgeons 232(6):p 889-898, June 2021. | DOI: 10.1016/j.jamcollsurg.2021.01.019
BACKGROUND:
Malignant cutaneous adnexal tumors (MCATs) are rare and their natural history is poorly understood. Available literature indicates aggressive behavior with a significant risk of metastasis.
STUDY DESIGN:
Retrospective review of our institutional surgical oncology databases was performed for patients diagnosed with MCATs (2001-2020). We hypothesized that most patients have a low risk of lymph node involvement, recurrence, and death. Kaplan-Meier statistical analysis was used to assess risk of recurrence and 5-year survival.
RESULTS:
We identified 41 patients diagnosed with MCATs (median age 59 years, 68% were men). Most patients had long-standing cutaneous lesions (median 24 months) and no palpable adenopathy. Most patients had stage I or II disease (98%). Primary tumors were treated with wide local excision (n = 28 [68%]), Mohs surgery (n = 5 [12%]), or amputation (n = 8 [19%]). Of 25 patients who underwent SLNB (61%), 1 had lymphatic metastasis. These include apocrine carcinoma (1 of 3), digital papillary adenocarcinoma (0 of 8), porocarcinoma (0 of 4), and additional MCAT sub-types (0 of 10). Three patients (7%) had disease recurrence at a median interval of 3.6 years (interquartile range 1.5 to 4.4 years). Five patients (12%) died at a median interval of 7 years (interquartile range 6.7 to 9.2 years), but only 1 patient was known to have succumbed to MCAT. Overall 5-year survival rate was 96% (95% CI, 75% to 99%).
CONCLUSIONS:
Despite the historical impression that MCATs have a high metastatic potential, most patients have low recurrence rates and excellent 5-year survival rates. Lymphatic disease identified after SLNB in early-stage tumors is rare and the value of this staging procedure in MCAT remains unclear.
© 2021 by Lippincott Williams & Wilkins, Inc.