Ann Dermatol.  2019 Dec;31(6):669-672. 10.5021/ad.2019.31.6.669.

Immediate Umbilical Reconstruction after a Mohs Micrographic Surgery for Primary Cutaneous Adenoid Cystic Carcinoma Arising in the Umbilicus

• Kim JE
• Roh MR
• Chung KY

• KMID: 2461991
• DOI: http://doi.org/10.5021/ad.2019.31.6.669

Abstract

Adenoid cystic carcinoma (ACC) is a malignant neoplasm of glands commonly occurs in salivary glands. Primary cutaneous adenoid cystic carcinoma (PCACC) is a rare form of ACC that primarily presents on the skin. Herein, we represent a rare case of PCACC occurred in the umbilicus in a 66-year-old Korean male patient. The patient visited our center with erythematous indurated patch on the umbilicus diagnosed as ACC by incisional biopsy at another center. The diagnosis of PCACC was confirmed by additional histopathologic examination and imaging study. We proceeded Mohs micrographic surgery and reconstructed umbilicus with tacked purse string suture. Local recurrence and distant metastasis were not observed during 30-month follow-up. We report this rare case of PCACC on the umbilicus so that dermatologist can aware of the rare disease. Furthermore, we recommend MMS and tacked purse string suture as effective methods for treatment of PCACC and immediate umbilical reconstruction.

Keyword

Immediate umbilical reconstruction; Mohs micrographic surgery; Primary cutaneous adenoid cystic carcinoma

MeSH Terms

Adenoids*
Aged
Biopsy
Carcinoma, Adenoid Cystic*
Diagnosis
Follow-Up Studies
Humans
Male
Mohs Surgery*
Neoplasm Metastasis
Rare Diseases
Recurrence
Salivary Glands
Skin
Sutures
Umbilicus*

Figure

• 

  Fig. 1 (A) An ill-defined erythematous nodule mainly on the left upper side of the umbilicus. (B) Surgical defect after 3 stages of Mohs micrographic surgery. Black circle denotes the location of the umbilicus. (C) Reconstruction of umbilicus in a centralized defect with tacked purse string sutures. (D) The umbilicus was well maintained after 20 months of follow-up.

• 

  Fig. 2 Histopathologic features of the excised tumor. (A) Basaloid tumor cells forming nests and cords in the dermis and subcutaneous tissue without connection to the epidermis (H&E, original magnification ×100). (B) Cribriform or tubular structure of the basaloid cells with abundant mucin inside (H&E, ×400). (C) Tumor cells had hyperchromatic nuclei but did not demonstrate distinct cellular atypia (H&E, ×400).

• 

  Fig. 3 (A) Deeper layered purse string sutures were placed to adjust the size of the umbilicus. (B) The superficial purse string suture involving the dermal layer was tacked at 3 areas at 12, 4, and 8 o'clock directions to the underlying linea alba. (C) Concave and normal looking umbilicus was recreated after tightening the purse string suture.

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