We describe a case of malignant eccrine acrospiroma in an 80-year-old man, and we review the literature on this tumor, with emphasis on the differential diagnosis.
A malignant eccrine acrospiroma (MEA) is a rare cutaneous tumor.
The diagnosis of MEA in this case was established by the presence of both a benign and malignant neoplasm in the same tumor--that is, there was a recognizable benign eccrine acrospiroma adjacent to the malignant tumor cells (figure 1).
The tumor in our patient would have been classified as an eccrine adenocarcinoma NOS if the benign eccrine acrospiroma component had not been present.
An eccrine acrospiroma is a deep dermal or subcutaneous nodular neoplasm that is sometimes connected to the epidermis.
Eccrine spiradenoma is made up of small, primitive-looking basaloid cells that are different from the squamoid cells seen in eccrine acrospiroma.
Although malignant acrospiromas can occur in all regions of the body, they are slightly more common on the head and neck (30%) and on the anterior trunk.
Although benign acrospiromas have been widely reviewed, reports of their malignant counterparts are rare.
Reports in the literature consistently emphasize the slow growth rate of both malignant and benign eccrine acrospiromas.
Such an approach, however, poses several problems; for example, (1) some carcinomas have no benign counterpart and do not fit the scheme (eg, ductal carcinoma, adenoid cystic carcinoma, and mucinous carcinoma); (2) poorly differentiated carcinomas can be diagnosed only when a contiguous adenoma is found histologically; (3) histologic classification can be very complicated because adenomas are numerous and their classification is complex; and (4) terminology includes unusual and difficult terms, deriving from the terminology used for adenomas (eg, malignant acrospiroma, porocarcinoma, hidradenocarcinoma, malignant cylindroma, malignant spiradenoma, and syringo-cystadenocarcinoma).
Acrospiroma maligno ad espressione clinica "zosteriforme.