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Microcystic adnexal carcinoma: reconstruction of a large centrofacial defect.

Lopez M, Cole EL - Plast Reconstr Surg Glob Open (2014)

Bottom Line: The patient was left with a large facial defect and remaining positive margins.We show that the patient's function and quality of life were not impeded despite reconstruction in light of positive margins for tumor.We believe that this case will draw the surgeon's attention to the possibility of palliative reconstruction in the treatment of a patient with large debilitating facial defects after microcystic adnexal carcinoma excision.

View Article: PubMed Central - PubMed

Affiliation: Division of Plastic Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, Tex.

ABSTRACT

Summary: We report a rare case of a large facial microcystic adnexal carcinoma in an elderly patient who underwent several rounds of excision. The patient was left with a large facial defect and remaining positive margins. The decision was made to stop further excision and proceed with reconstructive surgery. We show that the patient's function and quality of life were not impeded despite reconstruction in light of positive margins for tumor. We believe that this case will draw the surgeon's attention to the possibility of palliative reconstruction in the treatment of a patient with large debilitating facial defects after microcystic adnexal carcinoma excision.

No MeSH data available.


Related in: MedlinePlus

Preoperative photograph showing the original basal cell carcinoma.
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Figure 1: Preoperative photograph showing the original basal cell carcinoma.

Mentions: An 85-year-old otherwise healthy woman was referred from a major academic center department of dermatology after undergoing 12 stages of MMS. She originally presented to dermatology with a subcentimeter pearly papule of the left nasal tip (Fig. 1). Examination of the initial specimen revealed a typical infiltrating basal cell carcinoma of the deep reticular dermis. A second layer of tissue was obtained and focal areas of basal cell carcinoma were present. Interestingly, there were also many areas of syringomatous-like structures in the dermis that were characterized by small ductules containing abundant basophilic material and an associated host lymphocytic response. Initially, a diagnosis of an unusual morpheaform basal cell carcinoma was made. However, on further inspection, the syringomatous-like structures invaded deeply into the reticular dermis, subcutaneous fat, and underlying nasalis musculature. Given the overall histologic appearance coupled with the dermal response, MAC was added to the differential diagnosis. On further clinical examination, a subcentimeter flesh-colored plaque was visualized on the nasal dorsal surface. Examination of successive specimens revealed continued proliferation of the syringomatous-type lesions. There was no evidence of perineural invasion. The patient and her family were notified of a second cutaneous tumor of the face that appeared to be deeply invasive and multifocal. The patient continued to undergo a total of 12 stages of MMS in attempts to attain tumor-free tissue planes. After the twelfth stage, a 12 × 8 cm soft-tissue defect of the nose, glabella, and bilateral cheeks was present as well as extensive positive multifocal margins. The specimens were reviewed by multiple dermatopathologists both within and outside the institution, all of whom agreed with a diagnosis of MAC. The patient and her family then elected to terminate further excision despite positive margins. They were informed that the exact biological potential of the remaining disease could not be predicted and that further excision might be necessary if the tumor invaded a vital structure.


Microcystic adnexal carcinoma: reconstruction of a large centrofacial defect.

Lopez M, Cole EL - Plast Reconstr Surg Glob Open (2014)

Preoperative photograph showing the original basal cell carcinoma.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4255897&req=5

Figure 1: Preoperative photograph showing the original basal cell carcinoma.
Mentions: An 85-year-old otherwise healthy woman was referred from a major academic center department of dermatology after undergoing 12 stages of MMS. She originally presented to dermatology with a subcentimeter pearly papule of the left nasal tip (Fig. 1). Examination of the initial specimen revealed a typical infiltrating basal cell carcinoma of the deep reticular dermis. A second layer of tissue was obtained and focal areas of basal cell carcinoma were present. Interestingly, there were also many areas of syringomatous-like structures in the dermis that were characterized by small ductules containing abundant basophilic material and an associated host lymphocytic response. Initially, a diagnosis of an unusual morpheaform basal cell carcinoma was made. However, on further inspection, the syringomatous-like structures invaded deeply into the reticular dermis, subcutaneous fat, and underlying nasalis musculature. Given the overall histologic appearance coupled with the dermal response, MAC was added to the differential diagnosis. On further clinical examination, a subcentimeter flesh-colored plaque was visualized on the nasal dorsal surface. Examination of successive specimens revealed continued proliferation of the syringomatous-type lesions. There was no evidence of perineural invasion. The patient and her family were notified of a second cutaneous tumor of the face that appeared to be deeply invasive and multifocal. The patient continued to undergo a total of 12 stages of MMS in attempts to attain tumor-free tissue planes. After the twelfth stage, a 12 × 8 cm soft-tissue defect of the nose, glabella, and bilateral cheeks was present as well as extensive positive multifocal margins. The specimens were reviewed by multiple dermatopathologists both within and outside the institution, all of whom agreed with a diagnosis of MAC. The patient and her family then elected to terminate further excision despite positive margins. They were informed that the exact biological potential of the remaining disease could not be predicted and that further excision might be necessary if the tumor invaded a vital structure.

Bottom Line: The patient was left with a large facial defect and remaining positive margins.We show that the patient's function and quality of life were not impeded despite reconstruction in light of positive margins for tumor.We believe that this case will draw the surgeon's attention to the possibility of palliative reconstruction in the treatment of a patient with large debilitating facial defects after microcystic adnexal carcinoma excision.

View Article: PubMed Central - PubMed

Affiliation: Division of Plastic Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, Tex.

ABSTRACT

Summary: We report a rare case of a large facial microcystic adnexal carcinoma in an elderly patient who underwent several rounds of excision. The patient was left with a large facial defect and remaining positive margins. The decision was made to stop further excision and proceed with reconstructive surgery. We show that the patient's function and quality of life were not impeded despite reconstruction in light of positive margins for tumor. We believe that this case will draw the surgeon's attention to the possibility of palliative reconstruction in the treatment of a patient with large debilitating facial defects after microcystic adnexal carcinoma excision.

No MeSH data available.


Related in: MedlinePlus