title: Primary Adenoid Cystic Carcinoma of the Skin with Multiple Local Recurrences.
abstract: Primary adenoid cystic carcinoma (PACC) of the skin is a rare tumor with fewer than 70 cases studied in detail in the English literature. This type of tumor shows a prolonged course and a growth pattern usually manifested by multiple local recurrences and has a low potential for distant metastases. The most important modality for primary treatment is surgical resection followed by radiotherapy. We report a woman aged 43 years at the time of diagnosis, who presented with a slow-growing nodule in the right axilla without lymph node enlargement. A wide local excision was performed, and the histology revealed an adenoid cystic carcinoma. During the next 24 years, another four local recurrences were excised (the last one in 2015) and confirmed histologically to be adenoid cystic carcinoma. The patient was given 44 Gy of radiotherapy after the second surgery in 1996. PACC of the skin is a rare tumor with insufficient data concerning the efficacy of the surgical technique and chemotherapy and radiotherapy treatment, even more so in the case of multiple recurrences. After the last recurrence, the patient was offered an active follow-up based on the long tumor-free intervals in the past and because the site of the primary tumor allowed further surgical excisions in future recurrences.
authors.affiliation: Oncology Clinic, Complex Cancer Center, Plovdiv, Bulgaria.
authors.forename: Ivan Dimitrov
authors.initials: ID
authors.lastname: Tonev
authors.affiliation: Department of Pathology, Complex Cancer Center, Plovdiv, Bulgaria.
authors.forename: Yana Stoeva
authors.initials: YS
authors.lastname: Pirgova
authors.affiliation: Clinic of Medical Oncology, UMHAT 'St. Marina', Medical University Varna, Varna, Bulgaria ; Department of Propedeutics of Internal Diseases, Medical University Varna, Varna, Bulgaria.
authors.forename: Nikolay Vladimirov
authors.initials: NV
authors.lastname: Conev
keywords: Adenoid cystic carcinoma; Cylindroma; Skin