Introduction Squamoid eccrine ductal carcinoma (SEDC) is a rare malignancy, accounting for less than 0.1% of all cutaneous tumors. Clinically, SEDC typically presents as an asymptomatic erythematous papule or nodule, most often located on the head or neck region of elderly men. Histologically, SEDC demonstrates overlapping features of both squamous cell carcinoma (SCC) and ductal differentiation. Immunohistochemistry (IHC) is crucial for diagnosis, with CEA and EMA staining highlighting ductal differentiation. There is no consensus on the optimal management of SEDC. Treatment usually involves surgery, either with conventional excision, wide local excision (WLE) or Mohs micrographic surgery (MMS). Adjuvant radiation may be considered for patients with high-risk features, including positive margins, perineural invasion, lymph node involvement, high grade histology, multifocal or recurrent disease. Objective This study provides a review of 16 cases of SEDC, focusing on clinical presentation, histopathology, and treatment outcomes. The aim is to achieve a comprehensive characterization of its prognostic factors and optimal management. Materials and Methods A retrospective analysis was conducted on 16 patients diagnosed and/or treated for SEDC at the Veneto Institute of Oncology and at the University Hospital of Padua, between January 2012 and December 2024. Data were collected from reports of scheduled visits, surgical interventions reports, histologic examination. Results The disease predominantly affected elderly adults (mean age 76.2 years) and had a higher incidence in males (68.8%). Most tumors were located in the head and neck region, particularly on the face (43.8%), with a nodular or plaque-like appearance. Histological analysis revealed typical squamoid features with ductal differentiation, while immunohistochemical studies displayed positive staining for markers of eccrine differentiation (e.g., EMA, CEA, CK5/6). Conventional excision was performed in 14 cases, while one patient underwent WLE and axillary lymph nodes dissection. Due to the extensive spread of the tumor, one subject underwent radiotherapy (RT). Local recurrence was observed in 4 patients (25%), and among them two subjects showed lymph nodes metastasis and one experienced local sites metastasis. At 42 months, 35% of individuals were still free from disease, and from this point onward, they maintained this state up to 60 months. This data allows us to hypothesize that patients who do not experience recurrence for a long time are likely to maintain this state for an extended period. Only one patient died from SEDC 24 months after the diagnosis. Overall, the specific mortality rate was approximately 11.1%. Conclusions Given the rarity of this neoplasm and the limited available literature, further studies are essential to enhance understanding and improve the management of SEDC. Surgery remains the preferred treatment, where feasible, with radiation or chemotherapy considered as alternative option for extensive lesions. Additionally, prompt follow-up it is crucial due to the potential for recurrence.
Introduction Squamoid eccrine ductal carcinoma (SEDC) is a rare malignancy, accounting for less than 0.1% of all cutaneous tumors. Clinically, SEDC typically presents as an asymptomatic erythematous papule or nodule, most often located on the head or neck region of elderly men. Histologically, SEDC demonstrates overlapping features of both squamous cell carcinoma (SCC) and ductal differentiation. Immunohistochemistry (IHC) is crucial for diagnosis, with CEA and EMA staining highlighting ductal differentiation. There is no consensus on the optimal management of SEDC. Treatment usually involves surgery, either with conventional excision, wide local excision (WLE) or Mohs micrographic surgery (MMS). Adjuvant radiation may be considered for patients with high-risk features, including positive margins, perineural invasion, lymph node involvement, high grade histology, multifocal or recurrent disease. Objective This study provides a review of 16 cases of SEDC, focusing on clinical presentation, histopathology, and treatment outcomes. The aim is to achieve a comprehensive characterization of its prognostic factors and optimal management. Materials and Methods A retrospective analysis was conducted on 16 patients diagnosed and/or treated for SEDC at the Veneto Institute of Oncology and at the University Hospital of Padua, between January 2012 and December 2024. Data were collected from reports of scheduled visits, surgical interventions reports, histologic examination. Results The disease predominantly affected elderly adults (mean age 76.2 years) and had a higher incidence in males (68.8%). Most tumors were located in the head and neck region, particularly on the face (43.8%), with a nodular or plaque-like appearance. Histological analysis revealed typical squamoid features with ductal differentiation, while immunohistochemical studies displayed positive staining for markers of eccrine differentiation (e.g., EMA, CEA, CK5/6). Conventional excision was performed in 14 cases, while one patient underwent WLE and axillary lymph nodes dissection. Due to the extensive spread of the tumor, one subject underwent radiotherapy (RT). Local recurrence was observed in 4 patients (25%), and among them two subjects showed lymph nodes metastasis and one experienced local sites metastasis. At 42 months, 35% of individuals were still free from disease, and from this point onward, they maintained this state up to 60 months. This data allows us to hypothesize that patients who do not experience recurrence for a long time are likely to maintain this state for an extended period. Only one patient died from SEDC 24 months after the diagnosis. Overall, the specific mortality rate was approximately 11.1%. Conclusions Given the rarity of this neoplasm and the limited available literature, further studies are essential to enhance understanding and improve the management of SEDC. Surgery remains the preferred treatment, where feasible, with radiation or chemotherapy considered as alternative option for extensive lesions. Additionally, prompt follow-up it is crucial due to the potential for recurrence.
Monocentric retrospective study of 16 patients with squamoid eccrine ductal carcinoma: clinicopathologic features and therapeutic management
GNESOTTO, LAURA
2022/2023
Abstract
Introduction Squamoid eccrine ductal carcinoma (SEDC) is a rare malignancy, accounting for less than 0.1% of all cutaneous tumors. Clinically, SEDC typically presents as an asymptomatic erythematous papule or nodule, most often located on the head or neck region of elderly men. Histologically, SEDC demonstrates overlapping features of both squamous cell carcinoma (SCC) and ductal differentiation. Immunohistochemistry (IHC) is crucial for diagnosis, with CEA and EMA staining highlighting ductal differentiation. There is no consensus on the optimal management of SEDC. Treatment usually involves surgery, either with conventional excision, wide local excision (WLE) or Mohs micrographic surgery (MMS). Adjuvant radiation may be considered for patients with high-risk features, including positive margins, perineural invasion, lymph node involvement, high grade histology, multifocal or recurrent disease. Objective This study provides a review of 16 cases of SEDC, focusing on clinical presentation, histopathology, and treatment outcomes. The aim is to achieve a comprehensive characterization of its prognostic factors and optimal management. Materials and Methods A retrospective analysis was conducted on 16 patients diagnosed and/or treated for SEDC at the Veneto Institute of Oncology and at the University Hospital of Padua, between January 2012 and December 2024. Data were collected from reports of scheduled visits, surgical interventions reports, histologic examination. Results The disease predominantly affected elderly adults (mean age 76.2 years) and had a higher incidence in males (68.8%). Most tumors were located in the head and neck region, particularly on the face (43.8%), with a nodular or plaque-like appearance. Histological analysis revealed typical squamoid features with ductal differentiation, while immunohistochemical studies displayed positive staining for markers of eccrine differentiation (e.g., EMA, CEA, CK5/6). Conventional excision was performed in 14 cases, while one patient underwent WLE and axillary lymph nodes dissection. Due to the extensive spread of the tumor, one subject underwent radiotherapy (RT). Local recurrence was observed in 4 patients (25%), and among them two subjects showed lymph nodes metastasis and one experienced local sites metastasis. At 42 months, 35% of individuals were still free from disease, and from this point onward, they maintained this state up to 60 months. This data allows us to hypothesize that patients who do not experience recurrence for a long time are likely to maintain this state for an extended period. Only one patient died from SEDC 24 months after the diagnosis. Overall, the specific mortality rate was approximately 11.1%. Conclusions Given the rarity of this neoplasm and the limited available literature, further studies are essential to enhance understanding and improve the management of SEDC. Surgery remains the preferred treatment, where feasible, with radiation or chemotherapy considered as alternative option for extensive lesions. Additionally, prompt follow-up it is crucial due to the potential for recurrence.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/81459