A Clinical Experience of Microcystic Adnexal Carcinoma in Lower lip and Back

Choi, Young Woong; Oh, Suk Joon; Lee, Jong Wook; Jang, Young Chul; Chae, Seung Wan; Sohn, Jin Hee

Abstract

Microcystic adnexal carcinoma(MAC), or sclerosing sweat duct carcinoma, may best be considered as a sclerosing variant of ductal eccrine carcinoma. This tumor is a deeply invasive and aggressive neoplasm, which most commonly occurs on the skin of the upper lip, but it also occurs on the chin, nasolabial fold, or cheek. Local recurrence is common, however,metastases have not been reported. We have experienced 2 cases of microcystic adnexal carcinoma or sclerosing sweat ductal carcinoma, in lower lip including mandible bone, and in back. In the case of lower lip, the wide excision and partial mandiblectomy including 6 teeth and supraomohyoid neck dissection was performed, and the defect was covered with radial forearm free flap. For the prevention of lower lip drooping, we used the palmaris longus tendon which is harvested at the same time of flap elevation for the suspension of free radial forearm tissue. As the recipient vessel, the facial artery and facial vein was used. Immediately after the operation, the flap survival result was excellent, and the excised mandible bone and 6 teeth were replaced with denture. Fourteen months after the operation, the local recurrence is not notified. There was no difficulty of mastication nor speech, no lower lip drooping nor flap drooping. In case of back lesion, wide excision and split thickness skin graft was performed. We excised the lesion above level of the fascia. The split thickness skin was harvested from the left thigh, skin graft was performed on the fascia and completed in 10 days without loss.There is no local recurrence or specific complication except mild hypertrophic scar in the 10th month after the operation. We report these 2 cases with the review of literature that provide the guidance in treatment of microcystic adnexal carcinoma.