My brother was diagnosed with malignant acrospiroma of eyebrow, had a wide excision, but with a positive margins. He is coming to USA for definite treatment. Question - MMS? If yes, does he need lymphnode mapping, since this type of cancer is metastasizing. What would be the logistic for his evaluation/treatment - Mohs surgeon vs Head and neck surgeon? Lymphoscintigraphy? Thanks. Natalie.
Malignant Acrospiroma of Eyebrow - Need a Mohs Surgeon?
Doctor Answers 6
Acrospiroma of the eyebrow and Mohs micrographic surgery
Eccrine acrospiroma tumors are very rare. Mohs micrographic surgery is a very good treatment for tumors that are difficult to excise with clear margins as happened with your brother. Prior to travel and undergoing futher surgery, review of the microscopic slides of the biopsy and the excision would be worthwhile by a dermatopathologist for a second opinon. If Mohs surgery is done, some Mohs surgeons might recommend performing a final excision layer after the negative margins are obtained with Mohs, and the additional layer is then submitted to dermatopathology for further testing with permanent sections and possibly immunostain markers. A sentinnel lymph node biopsy can be performed after Mohs surgery by a referral to a surgical oncologist who performs such a test.
Mohs surgery is best option for most unusual tumors
Mohs surgery has 2 great benefits:
1. The highest cure rate for most skin cancers, including the more rare ones like acrospiromas. This is due to the manner in which the tissue is processed and read
2. It will allow repairs that lead to the least amount of scarring. Because of the way the tissue is processed, healthy skin can be spared, removing only the tumor and a minimal perimeter.
Plan to consult with a Mohs surgeon, who can perform the surgery and possibly also the repair. Alternatively, your Mohs surgeon may work with an oculoplastic surgeon for repair after the Mohs technique.
Malignant acrospiroma and surgery
Mohs surgery in coordination with sentinel lymph node biopsy with a head and neck surgeon would be a good way of assuring the best treatment for margin control and evaluating the lymph nodes. We often work together for cases like this.
A malignant acrospiroma or eccrine porocarcinoma is a rare tumor. The best way to initially remove the tumor is through Mohs surgery. Working with a Mohs surgeon and a head and neck surgeon (otolaryngologist) would be the most appropriate way to address this situation. A neck dissection will probably be required after the initial removal.
Mohs for malignant acrospiroma
Available literature supports Mohs surgery as an excellent option with cure rates superior to wide local excision. There have been few reports that support sentinel lymph node biopsy and/or nodal dissection as part of the work up for this type of tumor. Furthermore, adjuvant chemotherapy and/or radiation does not seem to improve survival in patients with advanced or recurrent cancer.
The initial evaluation should be with an experienced Mohs surgeon, who will then make a determination if an evaluation with ENT for nodal dissection is necessary. Most likely, sentinel node biopsy would be done first. Then Mohs surgery and reconstruction will be performed. If the sentinel node is positive for tumor, neck and/or parotid dissection will be done next. Close follow up is a must with these tumors.
Mohs is a good idea
Mohs is considered to be a good option since you want to make sure that the tumor is completely removed AND the least amount of tissue necessary is removed in order to accomplish this.
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