title: Cutaneous carcinosarcoma: adnexal vs. epidermal types define high- and low-risk tumors. Results of a meta-analysis.
abstract: OBJECTIVE
  We report four cases of cutaneous carcinosarcoma (CS) and perform a meta-analysis of the cutaneous CS literature.
  
  
  RESULTS
  CS occurred in elderly patients (mean of 80 years) on sun-damaged skin, and were keratotic papules of short duration. They did not recur after excision. CS exhibited basal cell carcinoma mixed with atypical fibroxanthoma cell populations. Immunophenotyping revealed vimentin+/keratin- spindle cells and vimentin-/keratin+ epithelial cells. Three cases exhibited p53 protein expression of both carcinomatous and sarcomatous components. Literature review identified 38 cases of cutaneous CS that could be broadly classified into two distinct groups. Epidermal-derived (basal or squamous cell carcinoma epithelial component) CS arose on the sun-damaged skin of the head and neck of elderly males (mean age 72 years) and had a 70% 5-year disease-free survival. In contrast, adnexal CS (spiradenocarcinoma, porocarcinoma, proliferating tricholemmal cystic carcinoma, or matrical carcinoma) occurred in younger patients (mean age 58 years), showed recent growth in a long-standing nodule and had a 25% 5-year disease-free survival. Age less than 65 years, recent growth, long-standing skin tumor, and tumor size greater than 2 cm significantly correlated with poor outcome.
  
  
  CONCLUSIONS
  Cutaneous CS is an aggressive skin cancer with high risk for advanced disease. Significant risk factors exist whose identification will allow for better management of CS patients.
authors.affiliation: Department of Pathology, Florida Orlando Hospital, Orlando, FL, USA.
authors.forename: Tien Anh
authors.initials: TA
authors.lastname: Tran
authors.forename: Sigfrid
authors.initials: S
authors.lastname: Muller
authors.forename: Prakash J
authors.initials: PJ
authors.lastname: Chaudahri
authors.forename: J Andrew
authors.initials: JA
authors.lastname: Carlson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism; D002280:Basal Cell Carcinoma / Q000145:classification / Q000378:metabolism / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000145:classification / Q000378:metabolism / Q000473:pathology; D002296:Carcinosarcoma / Q000145:classification / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D003937:Diagnosis, Differential; D004847:Epithelial Cells / Q000378:metabolism / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D018294:Neoplasms, Adnexal and Skin Appendage / Q000145:classification / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D039781:PubMed; D012878:Skin Neoplasms / Q000145:classification / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor