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• W2319330844 abstract "Hidroacanthoma simplex is a rare benign, intraepidermal, eccrine poroma, which is further classified into benign and malignant forms. It belongs to the family of sweat gland tumors, acrospiromas, which differentiate toward the acrosyringium, demonstrating ductal differentiation. These include poromas, hidradenomas, dermal duct tumors, and hidroacanthoma simplex. To the best of the authors' knowledge, malignant hidroacanthoma simplex has not been previously treated with Mohs micrographic surgery (MMS). A 79-year-old man with a history of chronic lymphocytic leukemia presented for an evaluation and management of a biopsy-confirmed malignant hidroacanthoma simplex on the scalp. On physical examination, there was a 6 × 5 mm ulcerated pink papule on the frontal scalp. Mohs micrographic surgery was performed, and the tumor was completely extirpated after 4 stages (Figure 1). Histology demonstrated an irregularly thickened epidermis with overlying areas of parakeratosis and orthokeratosis. Within the epidermis, there were nests of atypical poroid-appearing cells, displaying nuclear pleomorphism, atypical mitoses, and focal necrosis (Figure 2). Focal areas of ductal differentiation within the nests of cells were noted. The entire epidermis stained positively with cytokeratin AE 1/3, with the poroid cells staining lighter (Figure 3). Poroid cells also stained positively with epithelial membrane antigen (Figure 4) and negatively for carcinoembryonic antigen and cytokeratin 7. The findings were consistent with malignant hidroacanthoma simplex, and atypical cells were seen extending to all examined biopsy margins. The resulting postoperative defect was 35 × 30 mm and was reconstructed with an advancement flap. There was no tumor recurrence at his 4-, 11-, and 12-month follow-up visits.Figure 1: Postoperative defect after 4 stages of MMS.Figure 2: Nests of atypical poroid-appearing cells displaying nuclear pleomorphism, atypical mitoses, and focal necrosis. Hematoxylin and eosin stain, original magnification ×20.Figure 3: Cytokeratin AE 1/3 stains positive in the epidermis with poroid cells staining lighter, original magnification ×10.Figure 4: Poroid cells stained positively for epithelial membrane antigen, original magnification ×10.Discussion The acrospiroma family of sweat gland tumors favors the lower extremities but has also been found on the hands, neck, chest, nose, and eyelid. Malignant hidroacanthoma simplex, also known as porocarcinoma in situ, is a rare slow-growing tumor that rarely metastasizes. Clinically, it appears similar to a seborrheic keratosis or Bowen disease and is often misdiagnosed until biopsy. However, hidroacanthoma simplex with dermal invasion is regarded as porocarcinoma, which has a less favorable prognosis and higher chance of metastasis.1 Malignant transformation of hidroacanthoma simplex can occur, and dermatologists also must monitor for progression to invasive porocarcinoma.1 A study by Anzai et al2 reported malignant transformation in 10% of their 70 cases. Early excision or MMS has been suggested even for the benign form of hidroacanthoma simplex because of the risk for malignant transformation.1 To the best of the authors' knowledge, there are no reports of using MMS to treat malignant hidroacanthoma simplex, as the literature thus far only discusses conventional surgical excision for this neoplasm, without defined surgical margins. In the 3 articles that reported recurrence rates after performing conventional surgical excision, there was no recurrence at average 34 months.1,3,4 Mohs micrographic surgery has shown to be a very effective therapy for a number of contiguous malignant cutaneous tumors and has been successfully used in few cases of porocarcinoma as well.5 In treating porocarcinomas, MMS compared favorably with wide local excision with no local recurrences for as long as 60-month follow-up. In this case, given that the patient was immunocompromised (chronic lymphocytic leukemia) and the in situ tumor was located on the scalp, MMS was recommended when following the guidelines of the Mohs Appropriate Use Criteria for an equivalent tumor such as squamous cell carcinoma in situ. The surgery emphasized the need for MMS, given that it involved 4 stages with approximately 3-cm margins to clear the tumor, despite a small preclinical appearance. In conclusion, this case adds to the literature of this rare malignant neoplasm and showcases MMS as another effective treatment option for this tumor, especially in areas where tissue sparing is paramount." @default.
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• W2319330844 date "2015-04-01" @default.
• W2319330844 modified "2023-10-16" @default.
• W2319330844 title "Malignant Hidroacanthoma Simplex Treated With Mohs Surgery" @default.
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• W2319330844 doi "https://doi.org/10.1097/dss.0000000000000320" @default.
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