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Primary Cutaneous Mucinous Carcinoma at Forehead Skin- A Case Report and Literature Review

前額原發性皮膚黏液腺癌─病例報告及文獻回顧

摘要


背景:多數皮膚黏液腺癌是從其他部位轉移過來的,如:乳房或腸道黏液腺癌。原發性皮膚黏液腺癌為一非常罕見的汗腺分化型皮膚上皮癌。目的及目標:我們報告一例前額處的原發性黏液皮膚癌之年輕女性患者,因腫瘤位處美容單位,在兼顧腫瘤之完全切除及美觀考量,分享我們治療過程、方法、及結果。材料及方法:一位二十八歲,無其他過去病史的女性至門診求診,因左前額於半年前出現一小的、膚色、且無伴隨症狀的皮膚腫瘤。理學檢查初始認為良性皮膚囊腫並安排手術切除,病理報告為黏液腺癌,為排除從其他部位轉移至皮膚之可能,我們安排一系列的檢查,最後確診為原發性皮膚黏液腺癌。結果:第一次手術結果發現標本邊緣仍有腫瘤細胞,然而因腫瘤位處額頭有美觀考量,如果以一公分為邊緣切除,必須做植皮或局部皮瓣重建,將影響美觀,和患者溝通後,施以第二次切除手術及冷凍切片,此次標本邊緣並未發現有腫瘤細胞。經過每半年達一年半追蹤,目前並無局部復發或轉移之跡象,且此患者滿意整體治療成果。結 論:原發性皮膚黏液腺癌是非常罕見的。單憑病理報告無法確診,須藉一系列理學、鏡檢、及影像檢查,以排除為其他部位原發黏液腺癌轉移至皮膚之可能性,才能確定診斷。以一公分為邊緣切除病灶是標準手術方式,但若腫瘤位處美容單位,將影響美觀。我們以較少之邊緣切除腫瘤並於術中做冷凍切片,及術後長期規則追蹤,可達到兼顧腫瘤清除及美觀之治療結果。

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並列摘要


Background: Primary cutaneous mucinous carcinoma is a very rare malignant epithelial neoplasm. The majority of cutaneous mucinous carcinoma are dermal metastatic mucinous carcinoma from other sites, particularly from breast and gastrointestinal tract. Aim and objectives: Herein we present a young lady with this rare primary cutaneous mucinous carcinoma at a cosmetically sensitive region of the face, with our management experience. We also review the literature regarding its clinical presentation, specific histopathologic characteristics, and treatment. This report also differs from conventional treatment strategies of aggressive wide excision margins and is rare to take a conservative approach to managing such a rare lesion on a cosmetically sensitive part of the face. Materials and Methods: A 28-year-old healthy woman presented with a small, skin-colored, and asymptomatic nodule on left forehead skin for half a year. A benign cystic skin lesion was impressed initially, and surgical excision was performed. The pathology report showed mucinous carcinoma, and the outmost margin of the excised specimen was still involved by the tumor cells. Metastasis from other primary sites should be excluded first, and all the examinations showed normal results. Thus primary cutaneous mucinous carcinoma was diagnosed. Results: To achieve complete tumor excision and maximal aesthetic result, a second wide excision in a fusiform shape with margins of 0.4x 0.5 cm and frozen section were performed. The wound was primarily closed and the margins of the specimen were free of tumor cells. After eighteen months of follow-up, there was still no recurrence or metastasis. The patient was satisfied with the treatment outcomes. Conclusion: Primary cutaneous mucinous carcinoma is a low-grade, very rare, and low metastatic potential skin cancer. Surgical excision with an adequate margin is the choice of treatment. Due to its high recurrence rate, regular and long-term follow-up is necessary. Our outcomes demonstrate that a conservative excision margin may be undertaken in cosmetically sensitive areas such as the face.

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