Skin Cancer Unit, Department of Dermatology, Saint André's Hospital, Bordeaux, France.
Br J Dermatol. 2011 Nov;165(5):985-9. doi: 10.1111/j.1365-2133.2011.10486.x. Epub 2011 Sep 20.
Primary eccrine porocarcinoma is a rare cutaneous neoplasm and there is no consensus concerning its surgical management.
To conduct a retrospective analysis of all the cases of eccrine porocarcinoma seen in our hospital in order to identify prognostic factors.
Clinical data were retrieved from the patients' files. Each histological sample was reviewed by the pathologist and classified into three eccrine porocarcinoma subtypes: 'infiltrative', 'pushing' and 'pagetoid' eccrine porocarcinoma, according to Robson's criteria. Statistical methods were used to estimate the recurrence risk.
Twenty-four patients were included. The surgical margins realized were ≥ 2 cm or < 2 cm in six and 13 patients, respectively, and slow Mohs procedure was performed in two patients. Ten, seven and two patients presented with 'infiltrative', 'pushing' or 'pagetoid' eccrine porocarcinoma, respectively. Eight patients (of 23) experienced recurrences (35%). The recurrence risk was linked to the histological subtype: two out of two pagetoid eccrine porocarcinoma, four out of 10 'infiltrative' and none of seven 'pushing' eccrine porocarcinoma recurred (P=0·026). The recurrence risk was not associated with epidermal growth factor receptor status, nor the margin realized.
The recurrence risk of 'pushing' eccrine porocarcinoma is significantly lower than for 'infiltrative' eccrine porocarcinoma. Based on these considerations, a decisional algorithm might be proposed: first step, excisional biopsy of the primary eccrine porocarcinoma and identification of the histological subtype; second step, infiltrative or pagetoid porocarcinoma should be excised with an additional modified micrographic Mohs procedure, while no additional surgery is needed for 'pushing' eccrine porocarcinoma if the first excisional biopsy is complete. Although demonstrated in a limited case series, the histological subtype might guide the surgical management of primary eccrine porocarcinoma.
原发性小汗腺汗孔癌是一种罕见的皮肤肿瘤，其手术治疗尚无共识。
对我院所有汗孔癌病例进行回顾性分析，以确定预后因素。
从患者病历中检索临床资料。根据 Robson 标准，病理学家对每一例组织学样本进行审查，并将其分为三种小汗腺汗孔癌亚型：浸润性、推进性和 paget 样小汗腺汗孔癌。采用统计学方法估计复发风险。
共纳入 24 例患者。其中 6 例和 13 例患者的手术切缘分别≥2cm 和<2cm，2 例患者行缓慢 Mohs 手术。10、7 和 2 例患者分别表现为浸润性、推进性和 paget 样小汗腺汗孔癌。23 例中有 8 例（35%）患者出现复发。复发风险与组织学亚型相关：2 例 paget 样小汗腺汗孔癌均复发，10 例浸润性中有 4 例复发，7 例推进性无一例复发（P=0·026）。复发风险与表皮生长因子受体状态或切缘无关。
推进性小汗腺汗孔癌的复发风险明显低于浸润性小汗腺汗孔癌。基于这些考虑，可以提出一个决策算法：第一步，对原发性小汗腺汗孔癌进行切除活检，并确定组织学亚型；第二步，如果浸润性或 paget 样汗孔癌的首次切除活检完整，应采用额外的改良显微镜 Mohs 手术切除，而推进性小汗腺汗孔癌无需进一步手术。尽管该研究在有限的病例系列中进行，但组织学亚型可能指导原发性小汗腺汗孔癌的手术治疗。
