title: Surgery and Adjuvant Radiation for High-risk Skin Adnexal Carcinoma of the Head and Neck.
abstract: OBJECTIVE
  Skin adnexal carcinoma (SAC) is a rare cutaneous malignancy that arises from sebaceous and sweat glands. These carcinomas are believed to behave more aggressively than cutaneous squamous cell carcinomas (SCC) with a propensity for local recurrence. The role of adjuvant radiotherapy in SAC is undefined.
  
  
  METHODS
  We retrospectively reviewed all cases of head and neck SAC treated with surgery and adjuvant radiation from 2000 to 2012 at a single institution.
  
  
  RESULTS
  Nine cases were identified. Median age was 67 (range, 52 to 88) years. The histologies were: adnexal carcinoma (n=1), adnexal carcinoma with sebaceous differentiation (n=1), adnexal carcinoma with squamous differentiation (n=1), skin appendage carcinoma (n=1), sclerosing sweat duct carcinoma (n=1), mucinous carcinoma (n=1), ductal eccrine adenocarcinoma (n=1), porocarcinoma (n=1), and trichilemmal carcinoma (n=1). All tumors were reviewed by a dermatopathologist to confirm the SAC diagnosis.All patients had undergone surgery. Indications for adjuvant radiation included involved lymph nodes (n=4), perineural invasion (n=2), nodal extracapsular extension (n=2), positive margin (n=1), high-grade histology (n=6), multifocal disease (n=2), and/or recurrent disease (n=5). Radiation was delivered to the primary site alone (n=3), to the draining lymphatics alone (n=2), or to both (n=4). One patient received concurrent cisplatin. Median dose to the primary site was 60 Gy and to the neck was 50 Gy.Median follow-up was 4.0 years (range, 0.6 to 11.4 y). Locoregional control was 100%. Five-year progression-free survival was 89%. There was 1 acute grade 3 toxicity and no greater than or equal to grade 2 late toxicities were recorded.
  
  
  CONCLUSIONS
  Surgery and adjuvant radiation for high-risk SAC offers excellent locoregional control with acceptable toxicity.
authors.affiliation: Departments of *Radiation Oncology †Biostatistics ‡Pathology ∥Dermatology, Fox Chase Cancer Center §Department of Surgical Oncology, Head and Neck Surgery Section, Temple University Hospitals, Philadelphia, PA.
authors.forename: Lora S
authors.initials: LS
authors.lastname: Wang
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Handorf
authors.forename: Hong
authors.initials: H
authors.lastname: Wu
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Liu
authors.forename: Clifford S
authors.initials: CS
authors.lastname: Perlis
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Galloway
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local; D018294:Neoplasms, Adnexal and Skin Appendage / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D018714:Radiotherapy, Adjuvant / Q000379:methods*; D012189:Retrospective Studies