An 84-year-old female complains of bumps that developed on her right lower leg several months ago. She had salivary gland cancer that was diagnosed and surgically excised 10 years ago. Subsequently, she has been followed at yearly intervals by an oncologist. Examination of the affected ankle revealed scattered erythematous firm papules, slightly tender to palpation. A biopsy was obtained. What is your diagnosis?
Submit your diagnosis to see full explanation.
Histopathology revealed an eccrine carcinoma, and subsequent work-up uncovered brain metastases. Eccrine carcinomas are extraordinarily rare and occur most commonly on the scalp, extremities, or trunk of middle-aged or elderly individuals of both sexes.1 Clinically, the lesion presents as a firm nodule or plaque that can exceed 5 cm in diameter. Several histopathologic variants have been identified, and differentiation from apocrine tumors is often difficult 2,3 as is differentiation from metastatic breast carcinoma.4
Local recurrence and metastatic spread are of concern, and primary lesions are best removed by wide surgical excision with adjuvant radiation therapy and chemotherapy used for metastatic lesions.5,6
Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.
- Wick MR, Swanson PE. Cutaneous Adnexal Tumors. A Guide to Pathologic Diagnosis. Chicago: ASCP Press; 1991:10-13.
- Abenoza P, Ackerman AB. Neoplasms With Eccrine Differentiation. Philadelphia: Lea & Febiger; 1990:371-412
- Ansai S, Koseki S, Hozumi Y, Kondo S. An immunohistochemical study of lysozyme, CD-15 (Leu M1), and gross cystic disease fluid protein-15 in various skin tumors: assessment of the specificity and sensitivity of markers of apocrine differentiation. Am J Dermatopathol. 1995;17:249-255.
- Crowson AN, Magro CM, Mihm MC. Malignant adnexal neoplasms. Mod Pathol. 2006;19(Suppl 2):S93-S126.
- Nishizawa A, Nakanishi Y, Sasajima Y, Yamazaki N, Yamamoto A. Syringoid eccrine carcinoma with apparently aggressive transformation: case report and review of the literature. Int J Dermatol. 2006;45(10):1218-1221.
- Ballardini P, Marqutti G, Pedriali M, Querzoli P. Metastatic syringoid eccrine carcinoma of the nipple. Int Med Case Rep J. 2012;5:45-48.