Introduction

Primary cutaneous mucinous carcinoma (PCMC) is a rare low-grade malignant neoplasm originally believed to be of eccrine origin⁽¹⁾ These tumors are slow growing, arising on the face (particularly the eyelids), axilla, scalp, and trunk of middle-aged and older individuals⁽²⁾. The lesions typically present as erythematous, asymptomatic nodules measuring 0.5 to 7 cm in diameter; however, larger variants have been reported^(3-5) The contemporary, but still somewhat controversial, view is that these tumors actually demonstrate apocrine-type differentiation^(6-8)

Morbidity related to PCMC is primarily associated with incomplete resection^(9,10) While PCMC tends to grow slowly and have a good prognosis, late recurrences and rare metastases have been reported. Recurrence portends substantial morbidity, as recurrent tumors do not tend to respond to radiation treatment or chemotherapy⁽¹¹⁾

As is the case with many rare nonmelanoma tumors, there is no standard of care for the surgical treatment of PCMC. Currently employed modes of treatment for PCMC vary from standard excision to wide local excision, including dissection of regional lymph nodes⁽¹¹⁾. Mohs surgery was first introduced as a means for PCMC treatment by Weber et al^(11,12) in 1988. Due to the rarity of PCMS, the studies included were observational, primarily case reports and case series

Case Report

A 64 year old male presented to our clinics with chief complains of left axillary swelling for 4 month which was histologically proven to be cutaneous deposits of mucinous cystadenocarcinoma

Patient was examined and found to have no abnormality in oral cavity and no palpable cervical  and supraclavicular lymph nodes. In right axilla approximately 3cm*2.5cm firm non tender mobile lymph node was palpable.L axilla was NAD.

1. Lennox B, Pearse AG, Richards   Mucin-secreting tumours of the skin with special reference to the so-called mixed-salivary tumour of the skin and its relation to hidradenoma.  J Pathol Bacteriol. 1952; 64(4):865-880.PubMedGoogle Scholar Crossref
2. Papalas JA, Proia AD. Primary mucinous carcinoma of the eyelid: a clinicopathologic and immunohisto-chemical study of 4 cases and an update on recurrence rates.  Arch Ophthalmol. 2010;128(9):1160-1165. Article PubMed Google Scholar Crossref
3. Kavanagh GM, Rigby  HS, Archer    Giant primary mucinous sweat gland carcinoma of the scalp.  Clin Exp Dermatol. 1993;18(4):375-377. PubMed Google Scholar Crossref
4. Gupta A, Flowers FP, Lessner    Asymptomatic eyelid papule in a 57-year-old healthy man.  Arch Dermatol. 2000;136(11):1409-1414.Google Scholar Crossref
5. Nosrati N, Maender JL, Coleman  NM, Hsu    Asymptomatic plaque on the face: primary mucinous carcinoma of the skin.  Arch Dermatol. 2008;144(10):1383-1388. Article Google Scholar Crossref
6. Requena L, Kiryu H, Ackerman AB, Carter    Neoplasms With Apocrine Differentiation. Philadelphia, PA: Lippincott Raven; 1998.
7. Weedon D.Tumors of cutaneous appendages. In: Weedon D, ed.  Weedon's Skin Pathology.3rd ed. London, England: Churchill Livingstone Elsevier; 2010:790-791.
8. LeBoit PE, Burg G, Weedon  D, Sarasin  Pathology and Genetics of Skin Tumors. Lyon, France: IARC Press.
9. Wright JD, Font    Mucinous sweat gland adenocarcinoma of eyelid: a clinicopathologic study of 21 cases with histochemical and electron microscopic observations. Cancer. 1979;44(5):1757-1768. PubMed Google Scholar Crossref
10. Snow SN, Reizner GT. Mucinous eccrine carcinoma of the eyelid.  1992;70(8):2099-2104. PubMed Google Scholar Crossref
11. Breiting L, Christensen  L, Dahlstrøm  K, Breiting  V, Winther    Primary mucinous carcinoma of the skin: a population-based study.  Int J Dermatol. 2008;47(3):242-245.PubMedGoogle Scholar Crossref
12. Weber PJ, Hevia O, Gretzula JC, Rabinovitz    Primary mucinous carcinoma.  J Dermatol Surg Oncol. 1988;14(2):170-172. PubMed Google Scholar Crossref
13. Hemalatha AL, Kausalya SK, Amita K, Sanjay M, Lavanya MS. Primary mucinous eccrine adenocarcinoma A rare malignant cutaneous adnexal neoplasm at an unconventional site. J Clin Diagn Res 2014;8:FD14-
14. Bannur HB, Mastiholimath RD, Malur PR. Primary mucinous eccrine adenocarcinoma of the scalp: A case report. Acta Cytol2009;53:698-700.
15. Chen HS, Chen FM, Yang SF, Hsu JS. Primary cutaneous mucinous carcinoma of the breast. Kaohsiung J Med Sci 2014;30:587-8.
16. Terada T, Sato Y, Furukawa K, Sugiura M. Primary cutaneous mucinous carcinoma initially diagnosed as metastatic adenocarcinoma. Tohoku J Exp Med 2004;203:345-8.
17. Kotru M, Manucha V, Singh UR. Cytologic and histologic features of primary mucinous adenocarcinoma of skin in the axilla: A case report. Acta Cytol2007;51:571-4.
18. Laco J, Simáková E, Svobodová J, Ryska A. Recurrent mucinous carcinoma of skin mimicking primary mucinous carcinoma of parotid gland: A diagnostic pitfall. CeskPatol2009;45:79-82.
19. Kazakov DV, Suster S, LeBoit PE, Calonje E, Bisceglia M, Kutzner H, et al. Mucinous carcinoma of the skin, primary, and secondary: A clinicopathologic study of 63 cases with emphasis on the morphologic spectrum of primary cutaneous forms: Homologies with mucinous lesions in the breast. Am J Surg Pathol 2005;29:764-82.
20. Levy G, Finkelstein A, McNiff JM. Immunohistochemical techniques to compare primary vs. metastatic mucinous carcinoma of the skin. J Cutan Pathol2010;37:411-5.
21. Rollins-Raval M, Chivukula M, Tseng GC, Jukic D, Dabbs DJ. An immunohistochemical panel to differentiate metastatic breast carcinoma to skin from primary sweat gland carcinomas with a review of the literature. Arch PatholLab Med 2011;135:975-83.
22. Jih MH, Friedman PM, Kimyai-Asadi A, Goldberg LH. A rare case of fatal primary cutaneous mucinous carcinoma of the scalp with multiple in-transit and pulmonary metastases. J Am Acad Dermatol 2005;52 5 Suppl1:S76-80.
23. Kazakov DV, Suster S, LeBoit PE, et al. Mucinous carcinoma of the skin, primary, and secondary: a clinicopathologic study of 63 cases with emphasis on the morphologic spectrum of primary cutaneous forms: homologies with mucinous lesions in the breast. Am J SurgPathol. 2005;29:764–82. [Abstract] [Google Scholar
24. Headington JT. Primary mucinous carcinoma of skin: histochemistry and electron microscopy. Cancer. 1977;39: 1055–63. [Abstract] [Google Scholar]
25. Wright JD, Font RL. Mucinous sweat gland adenocarcinoma of eyelid: a clinicopathologic study of 21 cases with histochemical and electron microscopic observations. Cancer. 1979;44:1757–68. [Abstract] [Google Scholar]
26. Pilgrim JP, Kloss SG, Wolfish PS, Heng MC. Primary mucinous carcinoma of the skin with metastases to the lymph nodes. Am J Dermatopathol. 1985;7:461–9. [Abstract] [Google Scholar]
27. Requena L, Kiryu H, Ackerman AB. Neoplasms with apocrine differentiation. Philadelphia: Lippincott Williams & Wilkins; 1998. pp. 907–47. [Google Scholar]
28. Saigal RK, Khanna SD, Chander J. Apocrine gland carcinoma in axilla. Indian J Dermatol Venereol. 1971;37:177–80. [Abstract] [Google Scholar]
29. Aso K, Sato N. A case of primary mucinous carcinoma of the skin and trichofolliculoma developed in the same tissue. Jpn J Clin Dermatol. 1989;43:117–20. [Google Scholar]
30. Wako M, Nishimaki K, Kawamura N, et al. Mucinous carcinoma of the skin with apocrine-type differentiation: immunohistochemical studies. Am J Dermatopathol. 2003;25:66–70. [Abstract] [Google Scholar
31. Lennox B, Pearse AG, Richards HG. Mucin-secreting tumours of the skin with special reference to the so-called mixed-salivary tumour of the skin and its relation to hidradenoma. J PatholBacteriol. 1952; 64:865–80. [Abstract] [Google Scholar]
32. Robson A, Lazar AJ, Ben Nagi J, et al. Primary cutaneous apocrine carcinoma: a clinico-pathologic analysis of 24 cases. Am J Surg Pathol. 2008;32:682–90. [Abstract] [Google Scholar]

Dr MD Aqueel

SR SNMC Agra