Chiller K, Passaro D, Scheuller M, Singer M, McCalmont T, Grekin R C
Department of Dermatologic Surgery, University of California, San Francisco, 1701 Divisadero St, Third Floor, San Francisco, CA 94143, USA.
Arch Dermatol. 2000 Nov;136(11):1355-9. doi: 10.1001/archderm.136.11.1355.
Microcystic adnexal carcinoma, or sclerosing sweat duct carcinoma, is an uncommon cutaneous neoplasm associated with extensive local invasion. The standard of care with regard to the best excisional method in treating microcystic adnexal carcinoma has not been established.
To perform a retrospective study comparing patients treated by Mohs micrographic surgery with those treated by wide excision and to elucidate the epidemiological features of microcystic adnexal carcinoma.
A retrospective analysis of a case series involving 48 primary and referral patients diagnosed as having microcystic adnexal carcinoma using standardized criteria. All cases were reviewed by the same dermatopathologists.
Microcystic adnexal carcinoma predominantly affects the left side of the face of middle-aged women. Microcystic adnexal carcinoma is misdiagnosed 30% of the time. The recurrence rate is 1.98% per patient-year. Mohs micrographic surgery and simple excision show comparable complication rates. Clear margins were obtained in fewer procedures and, therefore, fewer office visits when the lesions were treated with micrographic surgery. The defect surface area after full extirpation following Mohs micrographic surgery was a mean of 4 times that of the clinically apparent size. The wide range of difference between the pre- and the post-Mohs micrographic surgery surface area noted in our data indicates that a margin cannot be safely predicted.
Microcystic adnexal carcinoma is a predominantly left-sided, locally aggressive facial tumor, which results in significant morbidity. Our data do not support the use of standardized predictable margins. Mohs micrographic surgery is a reasonable initial treatment, as it accomplishes cure in fewer office visits and does not rely on predicted margins.
微囊性附属器癌，又称硬化性汗腺导管癌，是一种少见的皮肤肿瘤，常伴有广泛的局部侵袭。目前尚未确立治疗微囊性附属器癌的最佳切除方法的护理标准。
进行一项回顾性研究，比较采用莫氏显微描记手术治疗的患者与采用广泛切除手术治疗的患者，并阐明微囊性附属器癌的流行病学特征。
对一组48例原发性及转诊患者的病例系列进行回顾性分析，这些患者均根据标准化标准诊断为微囊性附属器癌。所有病例均由同一位皮肤病理学家进行复查。
微囊性附属器癌主要累及中年女性面部左侧。微囊性附属器癌有30%的误诊率。每位患者每年的复发率为1.98%。莫氏显微描记手术和单纯切除的并发症发生率相当。当采用显微描记手术治疗病变时，获得切缘阴性所需的手术次数更少，因此门诊就诊次数也更少。莫氏显微描记手术完全切除后缺损的表面积平均是临床可见大小的4倍。我们数据中莫氏显微描记手术前后表面积的巨大差异表明无法安全地预测切缘。
微囊性附属器癌是一种主要累及左侧面部、具有局部侵袭性的肿瘤，会导致明显的发病率。我们的数据不支持使用标准化的可预测切缘。莫氏显微描记手术是一种合理的初始治疗方法，因为它在较少的门诊就诊次数中即可实现治愈，且不依赖于预测切缘。
