10.5826/dpc.1202a79
text/xml
2160-9381
1923
en
Alexander Katoulis
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
sweat gland tumor
Dermatoscopic features of a metastatic eccrine porocarcinoma arising on lymphedema
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2022-05-02
2021-07-30
2022-05-02
2022-05-24
e2022079
Dermatol Pract Concept
Alexander Katoulis
2022/05/02
10.5826/dpc.1202a79
e2022079
Second Department of Dermatology-Venereology, Attikon General University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
2160-9381
sweat gland tumor
en
e2022079
Edamitsu T, Minagawa A, Koga H, Uhara H, Okuyama R. Eccrine porocarcinoma shares dermoscopic characteristics with eccrine poroma: A report of three cases and review of the published work. J Dermatol. 2016;43(3):332-335. DOI: 10.1111/1346-8138.13082. PMID: 26333057.
Dermatoscopic features of a metastatic eccrine porocarcinoma arising on lymphedema
https://dpcj.org/index.php/dpc/article/download/1923/1576
     Dermatoscopic Features of a Metastatic Eccrine
        Porocarcinoma Arising on Lymphedema
                              Dimitrios Sgouros1, Eleni Routsi1, Zannis Almpanis2,
                                Athanasios Korogiannos3, Alexander Katoulis1


1 Second Department of Dermatology-Venereology, Attikon General University Hospital, National and Kapodistrian University of Athens,
  Medical School, Athens, Greece
2 Department of Pathology, 251 Hellenic Air Force General Hospital of Athens, Athens, Greece
3 Third Oncology Clinic, Herny Dunant Hospital, Athens, Greece



Key words: eccrine porocarcinoma, metastatic eccrine porocarcinoma, malignant eccrine poroma, sweat gland tumor
Citation: Sgouros D, Routsi E, Almpanis Z, Korogiannos A, Katoulis A. Dermatoscopic features of a metastatic eccrine porocarcinoma
arising on lymphedema. Dermatol Pract Concept. 2022;12(2):e2022079. DOI: https://doi.org/10.5826/dpc.1202a79
Accepted: September 15, 2021; Published: April 2022
Copyright: ©2022 Sgouros et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Dimitrios Sgouros, 2nd Department of Dermatology-Venereology, “Attikon” General University Hospital,
1 Rimini str, 12462, Chaidari, Athens, Greece. E-mail: disgo79@gmail.com




Introduction                                                             in patients with lymph node metastases poses EPC as a
                                                                         life-threatening cutaneous neoplasm [2].
Eccrine porocarcinoma (EPC) is a rare type of skin cancer                     Herein we report a rare case of metastatic EPC with a
arising from the intraepidermal portion of eccrine sweat                 zosteriform development on the right lower extremity.
glands or acrosyringium and comprises of 0.005% of all
malignant epithelial tumors with an equal prevalence in
                                                                         Case Presentation
both sexes and a predominance of elderly patients. The re-
ported incidence may be underestimated because EPC can                   An 85-year-old woman, Fitzpatrick phototype IV, presented
also mimic clinically and dermatoscopically several other                with 1-year history of multiple violaceous-black diffuse
benign or malignant cutaneous tumors (eg seborrheic ker-                 papules on the right thigh and a plaque on the mons pubis.
atosis, Bowen disease, melanoma, etc.) typically presenting              She had no symptoms or any discharge such as pain, itch
as an asymptomatic, painless and solitary nodule with ulcer-             or other. Of note, the patient suffered from a stable lymph-
ated surface also developing in former sites of irradiation,             edema of unknown origin in the right lower extremity for
lymphedema, and trauma [1,2]. EPC represents a tumor                     3 years while there was a preexisting scar on the right thigh
with aggressive biologic behavior and a tendency for local               due to a previously excised EPC 2 years ago with clear re-
recurrence and regional lymph nodes metastatic potential                 section margins. Previous dermatological history included
(about 20% in both scenarios). The mortality rate of 67%                 Bowen disease on the left leg presenting 1 year ago. Her




Research Letter | Dermatol Pract Concept. 2022;12(2):e2022079                                                                          1
past medical history also included arterial hypertension                squamoid differentiation (­Figure 1). Diagnostic work-up
and diabetes mellitus. The general examination showed no                with a computed tomography revealed infiltration of ho-
other abnormal findings. Dermoscopy revealed black col-                 molateral inguinal lymph nodes. Concerning vascularity
oration correlated with crusts covering areas of erosions.              our findings are in contrast to published literature since
Structureless pink-whitish background and a lack of ap-                 EPC as well as its benign counterpart, eccrine poroma,
parent vasculature were additional dermatoscopic findings,              mostly present with polymorphous vessels imitating amel-
as well. Fine scaling surrounding sites of erosions was also            anotic melanoma [1]. Our observation could be partially
evident in all lesions. Moreover, few papules exhibited                 explained by the presence of lymphedema that might had
pink-whitish ovoid areas. Two papules with such derma-                  caused suppression of vascular structures. In line with
toscopic characteristics were excised and histopathological             current evidence pink-whitish round areas seem to be a
examination showed an invasive, well-­differentiated poro-              common finding among EPCs correlating with edematous
carcinoma with focal epidermal attachments and partial                  sub-epidermal stroma ­reaction [2].




Figure 1. (A) Multiple violaceous-to-black papules coalescing into a plaque on the mons pubis. (B) Dermoscopy reveals that black color-
ation is associated with crusts surrounded by a structureless dark pink-to-purple background. (C) Multiple papules of a 5 mm of maximum
diameter are diffusely arranged on a lymphedematous right thigh. A scar due to a former excision of an EPC can be detected on the upper
external part of the extremity (black arrow). (D,E) A hint of fine scaling around areas of erosions and crusts (black arrows) and dermato-
scopically evident pink-to-white ovoid structures (white arrow) can be observed. (B, D, E) Lack of apparent vasculature is also prominent in
all dermatoscopic images. (F) Malignant neoplastic cells extended from the epidermis into the dermis with infiltrative growth pattern (black
arrow) and were composed of large, basaloid and atypical neoplastic cells with hyperchromatic nuclei. Depletion of vessels and lymphatic
vascular ectasia due to lymphedema (red arrow) are also prominent in histological images. (G) Eccrine porocarcinoma usually composed
of basaloid cells and many times it may show squamoid features (black arrow), resembles squamous cell carcinoma, but has sweat ducts or
duct-like structures (red arrow).




2                                                                           Research Letter | Dermatol Pract Concept. 2022;12(2):e2022079
Conclusions                                                     References
EPC represents a rare malignant cutaneous adnexal tumor         1. Sgouros D, Piana S, Argenziano G, et al. Clinical, dermoscopic
                                                                   and histopathological features of eccrine poroid neoplasms.
with non-specific clinical and dermatoscopic features. His-
                                                                   ­Dermatology. 2013;227(2):175–179. DOI: 10.1159/000354152.
tory of previously excised EPC and lymphedema constitute
                                                                    PMID: 24080919.
risk factors for the development of metastatic cutaneous dis-   2. Edamitsu T, Minagawa A, Koga H, Uhara H, Okuyama R. ­Eccrine
ease. Dermatoscopically observed pink-to-white ovoid struc-         porocarcinoma shares dermoscopic characteristics with eccrine
tures and whitish fine scaling surrounding areas of erosions        poroma: A report of three cases and review of the published
over a vague pinkish background may be of help for the              work. J Dermatol. 2016;43(3):332–335. DOI: 10.1111/1346-
                                                                    8138.13082. PMID: 26333057.
early detection of this life-threatening neoplasm.
   Consent: Patient has provided written consent for her
data publication




Research Letter | Dermatol Pract Concept. 2022;12(2):e2022079                                                                  3
