Annals of Surgical Oncology

, Volume 8, Issue 1, pp 60–64 | Cite as

Treatment of Malignancy Arising in Pilonidal Disease

  • Eelco de Bree
  • Frans A. N. Zoetmulder
  • Manousos Christodoulakis
  • Berthe M. P. Aleman
  • Dimitris D. Tsiftsis
Original Article

Abstract

Background: Malignant degeneration is a rare complication of pilonidal disease and is associated with a high recurrence rate and poor prognosis compared with regular nonmelanoma skin cancer. Treatment in our departments and in the international literature was evaluated.

Methods: We analyzed the data from three patients with malignant degeneration who were treated in our departments and an additional 56 patients who were found after an extensive literature search.

Results: A total of 47 males and 12 females, with a mean age of 52 years, were most frequently primarily treated with surgery. After a mean follow-up time of 28 months, 20% of all patients died with evidence of disease and an additional 10% died of unrelated causes. The overall recurrence rate was 39%, with a median time to recurrence of only 9 months. The local recurrence rate was lower when radiotherapy was added to surgical treatment alone (30% vs. 44%). Re-excision of local recurrence resulted in some long-term survivals.

Conclusions: Early diagnosis and treatment may lead to improvement of the relative poor prognosis. Surgical treatment should be tailored according to the locoregional extent. The high recurrence rate after surgical treatment can be reduced by the addition of radiotherapy. Although repeat surgery for recurrent disease may involve extensive resection and morbidity, this may result in prolonged survival.

Key Words

Pilonidal disease Malignant degeneration Squamous cell carcinoma Surgical treatment Radiotherapy 

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REFERENCES

  1. 1.
    Val-Bernal JF, Azcaretazabal T, Garijo MF. Pilonidal sinus of the penis. A report of two cases, one of them associated with actinomycosis. J Cutan Pathol 1999; 26: 155–8.PubMedGoogle Scholar
  2. 2.
    Davis KA, Mock CN, Versaci A, Lentrichia P. Malignant degeneration of pilonidal cysts. Am Surg 1994; 60: 200–4.PubMedGoogle Scholar
  3. 3.
    Santanelli F, Rubino C, Innocenzi D, Ribuffo D, Scuderi N. Free flap failure in a patient with a long standing, infected squamous cell carcinoma. Scan J Plast Hand Surg 1994; 28: 305–8.Google Scholar
  4. 4.
    Kulaylat MN, Gong M, Doerr RJ. Multimodality treatment of squamous cell carcinoma complicating pilonidal disease. Am Surg 1996; 62: 922–9.PubMedGoogle Scholar
  5. 5.
    Jeddy TA, Vowles RH, Southam JA. Squamous cell carcinoma in chronic pilonidal disease. Br J Clin Pract 1994; 48: 160–1.PubMedGoogle Scholar
  6. 6.
    Gur E, Neligan PC, Shafir R, Reznick R, Cohen M, Shpitzer T. Squamous cell carcinoma in perineal inflammatory disease. Ann Plast Surg 1997; 38: 653–7.PubMedGoogle Scholar
  7. 7.
    Abboud B, Ingea H. Recurrent squamous-cell carcinoma arising in sacrococcygeal pilonidal sinus tract: report of a case and review of the literature. Dis Colon Rectum 1999; 42: 525–8.PubMedGoogle Scholar
  8. 8.
    Williamson JD, Silverman JF, Tafra L. Fine-needle aspiration cytology of metastatic squamous-cell carcinoma arising in a pilonidal sinus, with literature review. Diagn Cytopathol 1999; 20: 367–70.PubMedGoogle Scholar
  9. 9.
    Anscombe AM, Isaacson P. An unusual variant of squamous cell carcinoma (inverted verrucous carcinoma) arising in a pilonidal sinus. Histopathology 1983; 7: 123–7.PubMedGoogle Scholar
  10. 10.
    Jamieson NV, Goode TB. Squamous cell carcinoma arising in a pilonidal sinus presenting with the formation of an abscess. Postgrad Med J 1982; 58: 720–1.PubMedGoogle Scholar
  11. 11.
    Kim YA, Thomas I. Metastatic squamous cell carcinoma arising in a pilonidal sinus. J Am Acad Dermatol 1993; 29: 272–4.CrossRefPubMedGoogle Scholar
  12. 12.
    Mashiah A, Kogan I, Nissim F. Primary squamous cell carcinoma of the pilonidal area. Cutis 1984; 33: 582–3.PubMedGoogle Scholar
  13. 13.
    Kaplan RP. Cancer complicating chronic ulcerative and scarifying mucocutaneous disorders. Adv Dermatol 1987; 2: 19–46.PubMedGoogle Scholar
  14. 14.
    Wolff H. Carcinom auf dem Boden des Dermoids. Arch Klin Chir 1900; 62: 731–8.Google Scholar
  15. 15.
    Fasching MC, Meland NB, Woods NB, Wolff BG. Recurrent squamous cell arising in pilonidal sinus tract - multiple flap reconstructions: Report of a case. Dis Colon Rectum 1989; 32: 153–8.PubMedGoogle Scholar
  16. 16.
    Giampapa V, Keller A, Shaw W, Cohen S. Pelvic floor reconstruction using the rectus abdominis muscle flaps. Ann Plast Surg 1984; 13: 56–63.PubMedGoogle Scholar
  17. 17.
    Shukla HS, Hughes LE. The rectus abdominis flap for perineal wounds. Ann R Coll Surg Engl 1984; 66: 337–9.PubMedGoogle Scholar
  18. 18.
    Bartelink H, Roelofsen F, Eschwege F, et al. Concomitant radiotherapy and chemotherapy is superior to radiotherapy in the treatment of locally advanced anal cancer: Results of a phase III randomized trial of the European Organization for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups. J Clin Oncol 1997; 15: 2040–9.PubMedGoogle Scholar
  19. 19.
    Cohen AM, Wong WD. Anal squamous cell cancer nodal metastases: prognostic significance and therapeutic considerations. Surg Oncol Clin N Am 1996; 5: 203–10.PubMedGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 2001

Authors and Affiliations

  • Eelco de Bree
    • 1
    • 4
  • Frans A. N. Zoetmulder
    • 1
  • Manousos Christodoulakis
    • 3
  • Berthe M. P. Aleman
    • 2
  • Dimitris D. Tsiftsis
    • 3
  1. 1.Department of Surgical OncologyUniversity HospitalAmsterdamTHE Netherlands
  2. 2.Department of RadiotherapyThe Netherlands Cancer Institute/Antoni van Leeuwenhoek HuisAmsterdamTHE Netherlands
  3. 3.Department of Surgical OncologyUniversity HospitalHerakleionGreece
  4. 4.Department of Surgical OncologyUniversity HospitalHerakleionGreece

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