Advertisement

European Journal of Plastic Surgery

, Volume 42, Issue 6, pp 623–627 | Cite as

Eccrine porocarcinoma of the scalp: diagnosis and importance of early surgical intervention

  • Maxime De Fré
  • Katrien Smets
  • Michal Ulicki
  • Veronique Verhoeven
  • Vasiliki Siozopoulou
  • Tine Strobbe
  • Specenier Pol
  • Olivier Aerts
  • Julien Lambert
  • Thierry Tondu
  • Filip E. F. ThiessenEmail author
Case Report
  • 40 Downloads

Abstract

Eccrine porocarcinoma is a rare and potentially fatal malignant adnexal tumor that can arise de novo or develop from its benign precursor, poroma. Diagnosis is difficult due to its rarity and resemblance to many other (benign) skin tumors. We present the case of a 71-year-old woman presenting with a long-standing case of eccrine porocarcinoma on the scalp. After multiple incomplete excisions over the last 15 years, no metastases were found. Major reconstructive surgery was necessary after complete excision of the lesion. Complete removal of the eccrine porocarcinoma was achieved in 2 stages. The defect was closed with a large rotation flap of the scalp. No adjuvant radio- or chemotherapy was given. Twenty-one months later, the patient presented with a rapidly growing lymph node recurrence, which was treated by lymph node dissection followed by chemoradiation. This case demonstrates the consequences of suboptimal surgical treatments and follow-up of eccrine porocarcinoma and its benign precursor, poroma. Early recognition, proper pathological diagnosis, and adequate surgical treatment are highly recommended in order to obtain a good prognostic outcome.

Level of evidence: Level V, Risk/Prognostic study.

Keywords

Poroma Eccrine porocarcinoma Histopathology Immunohistochemistry Mohs micrographic surgery Plastic surgery 

Notes

Conflict of interest

Maxime De Fré, Katrien Smets, Michal Ulicki, Veronique Verhoeven, Vasiliki Siozopoulou, Tine Strobbe, Specenier Pol, Olivier Aerts, Julien Lambert, Thierry Tondu, and Filip E. F. Thiessen declare that they have no conflict of interest.

Ethical approval

All applicable international, national, and/or institutional guidelines were followed.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Patient consent

Patient consent was obtained for publication of this manuscript and complementary images.

References

  1. 1.
    Salih AM, Kakamad FH, Baba HO et al (2017) Porocarcinoma; presentation and management, a meta-analysis of 453 cases. Ann Med Surg 20:74–79 [cited 2018 May 19] Available from: http://www.ncbi.nlm.nih.gov/pubmed/28721214 CrossRefGoogle Scholar
  2. 2.
    Riera-Leal L, Guevara-Gutiérrez E, Barrientos-García JG, Madrigal-Kasem R, Briseño-Rodríguez G, Tlacuilo-Parra A (2015) Eccrine porocarcinoma: epidemiologic and histopathologic characteristics. Int J Dermatol 54:580–586CrossRefGoogle Scholar
  3. 3.
    Nazemi A, Higgins S, Swift R, et al. (2018) Eccrine Porocarcinoma. Dermatologic Surg. [internet]. [cited 2018 Sep 18];1. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29894433 CrossRefGoogle Scholar
  4. 4.
    Brown CW Jr, Dy LC (2008) Eccrine porocarcinoma. Dermatol Ther 21:433–438 [cited 2018 May 19] Available from: http://www.ncbi.nlm.nih.gov/pubmed/19076620 CrossRefGoogle Scholar
  5. 5.
    Robson A, Greene J, Ansari N, Kim B, Seed PT, McKee PH, Calonje E (2001) Eccrine porocarcinoma (malignant eccrine poroma): a clinicopathologic study of 69 cases. Am J Surg Pathol 25:710–720 [cited 2018 May 19] Available from: http://www.ncbi.nlm.nih.gov/pubmed/11395548 CrossRefGoogle Scholar
  6. 6.
    Shaw M, McKee PH, Lowe D et al (1982) Malignant eccrine poroma: a study of twenty-seven cases. Br J Dermatol 107:675–680CrossRefGoogle Scholar
  7. 7.
    Lloyd MS, El-Muttardi N, Robson A (2003) Eccrine porocarcinoma: a case report and review of the literature. Can J Plast Surg 11:153–156 [cited 2019 Jun 3] Available from: http://www.ncbi.nlm.nih.gov/pubmed/24115860 CrossRefGoogle Scholar
  8. 8.
    Sawaya JL, Khachemoune A (2014) Poroma: a review of eccrine, apocrine, and malignant forms. Int J Dermatol 53:1053–1061 [cited 2018 May 19] Available from: http://doi.wiley.com/10.1111/ijd.12448 CrossRefGoogle Scholar
  9. 9.
    Song SS, Wu Lee W, Hamman MS et al (2015) Mohs micrographic surgery for eccrine porocarcinoma. Dermatologic Surg 41:301–306 [cited 2018 may 19] Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00042728-201503000-00001 CrossRefGoogle Scholar
  10. 10.
    Salih AM, Kakamad FH, Essa RA et al (2017) Porocarcinoma: a systematic review of literature with a single case report. Int J Surg Case Rep 30:13–16 [cited 2018 May 19] Available from: http://www.ncbi.nlm.nih.gov/pubmed/27898349 CrossRefGoogle Scholar
  11. 11.
    Ramasenderan N, Shahir H, Omar SZ (2018) A synchronous incidence of eccrine porocarcinoma of the forearm and facial squamous cell carcinoma: a case report. Int J Surg Case Rep 42:116–120 [cited 2018 May 19] Available from: http://www.ncbi.nlm.nih.gov/pubmed/29245095 CrossRefGoogle Scholar
  12. 12.
    Horwich MD, Finch J, Ibrahimi O et al (2017) Eosinophilic variant of eccrine porocarcinoma of the scalp: case report and review of the literature. Int J women’s dermatology 3:157–160 [cited 2018 May 19] Available from: http://www.ncbi.nlm.nih.gov/pubmed/28831427 CrossRefGoogle Scholar
  13. 13.
    Goto K, Takai T, Fukumoto T, Anan T, Kimura T, Ansai SI, Oshitani Y, Murata Y, Sakuma T, Hirose T (2016) CD117 (KIT) is a useful immunohistochemical marker for differentiating porocarcinoma from squamous cell carcinoma. J Cutan Pathol 43:219–226 [cited 2018 Oct 19] Available from: http://www.ncbi.nlm.nih.gov/pubmed/26449497 CrossRefGoogle Scholar
  14. 14.
    Belin E, Ezzedine K, Stanislas S et al (2011) Factors in the surgical management of primary eccrine porocarcinoma: prognostic histological factors can guide the surgical procedure. Br J Dermatol 165:985–989 [cited 2018 May 19] Available from: http://doi.wiley.com/10.1111/j.1365-2133.2011.10486.x CrossRefGoogle Scholar
  15. 15.
    Kurashige Y, Minemura T, Nagatani T (2013) Eccrine porocarcinoma: clinical and pathological report of eight cases. Case Rep Dermatol 5:259–266 [cited 2018 Sep 22] Available from: http://www.ncbi.nlm.nih.gov/pubmed/24403888 CrossRefGoogle Scholar
  16. 16.
    Tenna S, Brunetti B, Aveta A, Poccia I, Persichetti P (2013) Scalp reconstruction with superficial temporal artery island flap: clinical experience on 30 consecutive cases. J Plast Reconstr Aesthetic Surg 66:660–666 [cited 2019 May 30] Available from: http://www.ncbi.nlm.nih.gov/pubmed/23415876 CrossRefGoogle Scholar
  17. 17.
    Gerber PA, Schulte K-W, Ruzicka T, Bruch-Gerharz D (2008) Eccrine porocarcinoma of the head: an important differential diagnosis in the elderly patient. Dermatology 216:229–233 [cited 2018 May 21] Available from: https://www.karger.com/Article/FullText/112931 CrossRefGoogle Scholar
  18. 18.
    Jeon H, Smart C (2015) An unusual case of porocarcinoma arising on the scalp of a 22-year-old woman. Am J Dermatopathol 37:237–239 [cited 2018 Sep 22] Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00000372-201503000-00009 CrossRefGoogle Scholar
  19. 19.
    Boam T, Szczap A, Mendes da Costa T et al (2017) A case of massive porocarcinoma. Ann R Coll Surg Engl 99:e230–e232 [cited 2018 Sep 23] Available from: http://www.ncbi.nlm.nih.gov/pubmed/29022792 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Maxime De Fré
    • 1
  • Katrien Smets
    • 2
  • Michal Ulicki
    • 2
  • Veronique Verhoeven
    • 3
  • Vasiliki Siozopoulou
    • 4
    • 5
  • Tine Strobbe
    • 2
  • Specenier Pol
    • 6
  • Olivier Aerts
    • 2
  • Julien Lambert
    • 2
  • Thierry Tondu
    • 1
    • 7
  • Filip E. F. Thiessen
    • 1
    • 7
    Email author
  1. 1.Department of Plastic, Reconstructive and Aesthetic SurgeryAntwerp University HospitalEdegemBelgium
  2. 2.Department of DermatologyAntwerp University HospitalEdegemBelgium
  3. 3.Department of Primary and Interdisciplinary Care (ELIZA) – Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
  4. 4.Department of PathologyAntwerp University HospitalEdegemBelgium
  5. 5.University of AntwerpAntwerpBelgium
  6. 6.Department of Oncology, Faculty of Medicine and Health SciencesAntwerp University HospitalEdegemBelgium
  7. 7.ZNA Middelheim HospitalAntwerpBelgium

Personalised recommendations