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Surgical management and lymph-node biopsy of rare malignant cutaneous adnexal carcinomas: a population-based analysis of 7591 patients

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Abstract

Objective

To analyze the prognosis of cutaneous adnexal malignancies, survival relative to surgical management, and utility of lymph-node biopsy.

Design

Population-based study of the SEER-18 database from 1975 to 2016.

Participants

7591 patients with sweat gland carcinoma, hidradenocarcinoma, spiradenocarcinoma, sclerosing sweat duct tumor/microcystic adnexal tumor (SSDT/MAC), porocarcinoma, eccrine adenocarcinoma, and sebaceous carcinoma

Results

Five-year OS ranged from 68.0 to 82.6%, while 5-year DSS ranged from 94.6 to 99.0%. The majority of patients were treated with narrow (42.4%) or wide local excision (16.9%). DSS at 5 years showed that patients with stage IV had significantly poorer survival (50.3%) than I, II, or III (99.3%, 97.8%, and 89.0% respectively). 5-year OS was significantly higher for narrow excision (excision with < 1 cm margin, 78.5%) than observation (65.0%), excisional biopsy (66.8%), or wide local excision (WLE, 73.2%). Lymph-node biopsy was performed in a minority of cases (8.1%) and patients showed no significant difference in survival based on nodal status. The sensitivity and specificity of lymph-node biopsy for all malignancies were 46% and 80%, respectively. The PPV and NPV for that group were 0.46 and 0.80, respectively. Invasion of deep extradermal structures was a poor predictor of nodal positivity.

Conclusions

These malignancies have excellent DSS. Narrow excisions demonstrate better 5-year DSS and OS compared with WLE. Lymph-node biopsy is a poor predictor of survival in advanced stage disease and utility is limited.

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Funding

Research reported in this publication was supported by NIH Grant P30 CA77598 utilizing the Biostatistics and Bioinformatics Core shared resource of the Masonic Cancer Center, University of Minnesota, and by the National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1-TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Dermatology, University of Minnesota, 516 Delaware St SE, Minneapolis, MN, 55401, USA

    Amrita Goyal, Kavita Goyal, Kimberly Bohjanen & Ian Maher

  2. University of Minnesota Medical School, Minneapolis, MN, USA

    Theodore Marghitu

  3. Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA

    Nikhil Goyal

  4. Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA

    Nathan Rubin

  5. Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA

    Krishnan Patel

  6. Department of Radiation Oncology, University of Minnesota, Minneapolis, MN, USA

    Daniel O’Leary

Authors
  1. Amrita Goyal
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  2. Theodore Marghitu
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  3. Nikhil Goyal
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  4. Nathan Rubin
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  5. Krishnan Patel
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  6. Kavita Goyal
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  7. Daniel O’Leary
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  8. Kimberly Bohjanen
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  9. Ian Maher
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Contributions

Drs. AG and IM had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: AG; acquisition, analysis, and interpretation of data: AG; drafting of the manuscript: AG; critical revision of the manuscript for important intellectual content: AG, TM, NG, NR, KP, KG, DO, KB, and IM. Statistical analysis: AG and NR; obtained funding: NR. Administrative, technical, or material support: AG; study supervision and research mentorship: IM.

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Correspondence to Amrita Goyal.

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The authors report no conflicts of interest relevant to this manuscript and have no other financial relationships to disclose.

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Goyal, A., Marghitu, T., Goyal, N. et al. Surgical management and lymph-node biopsy of rare malignant cutaneous adnexal carcinomas: a population-based analysis of 7591 patients. Arch Dermatol Res 313, 623–632 (2021). https://doi.org/10.1007/s00403-020-02143-5

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  • DOI: https://doi.org/10.1007/s00403-020-02143-5

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