Microcystic adnexal carcinoma involving a large portion of the face: when is surgery not reasonable?

BACKGROUND: We report a case of microcystic adnexal carcinoma (MAC) involving a large portion of the face, one of the largest of any MAC reported thus far in this area, and review the literature regarding the nature of the tumor and available treatments. We also review all of the reported cases of metastases and the possible role of radiation in the etiopathogenesis of this tumor.

OBJECTIVE: To review the literature about what is known about therapy for MAC and what options are available to patients who have this disease.

MATERIALS AND METHODS: Case report and review of the literature.

RESULTS: Of the 274 cases of MAC thus far reported, there are 6 cases of metastases, only 1 of which resulted in death.

CONCLUSION: Mohs surgery should be the treatment of choice for this tumor; however, when extirpation entails sufficiently large morbidity, given the low rate of metastases and mortality, observation is a reasonable alternative.