Case Report: Skin adnexal carcinoma of the upper lip

Introduction Microcystic adnexal carcinoma (MAC) is a rare malignant skin tumor, which derives from hair follicles, sweat or sebaceous glands. It is frequently located on the face, especially upper lip, lower lip and nasolabial folds. The tumor affects both genders, commonly adults, at ages of 40-80 years, with an incidence of about 0,005 %.

Case report A 79-year-old woman presented with a slowly growing tumor of the upper lip. The clinical examination showed an upper lip mass, which measured about 1 cm. The skin was intact. A biopsy was performed. Intraoperatively an infiltration of the skin was proved, so that it also had to be resected. Histology proved a microcystic adnexal carcinoma. The staging examinations (neck ultrasound, chest CAT scan, abdominal ultrasound) showed no metastases. Complete tumor resection and selective neck dissection level I-III was carried out. The upper lip defect was recontructed with a combined rotation-transposition flap (modified Karapandzic flap). Histopathological tumor staging was pT1 pN0 R1, so that another resection cranially followed, in order to achieve an R0 status. After the operation, a very good functional and aesthetic result was obtained and regular follow ups were planned.

Discussion MAC is a very rare well differentiated malignant tumor, which clinically presents as a slowly growing, hard, painless, skin colored mass. The first line treatment is the surgical resection with clear surgical margins. A recurrence rate of 40 % is reported, but regional or distant metastases are rare. Because of its slow growing, it is considered to be radioresistant and chemoresistant. Evaluation of adjuvant radiation therapy is presently being considered.

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Publication History

Article published online:
10 June 2020