[Malignant cutaneous adnexal neoplasms of the face and scalp: Diagnostic and therapeutic update].
BACKGROUND
Malignant cutaneous adnexal neoplasms are rare and have been characterized only recently. They can occur at any age but preferentially in elderly. There are 3 of them: trichoblastic carcinoma, trichilemmal carcinoma and malignant pilomatricoma. The aim of our study was to make a diagnostic and therapeutic update about these tumors when located at the face or at the scalp.


METHODS
A bibliographic research was made on PubMed using following keywords: appendage skin carcinoma AND pathology AND/OR therapeutic. Articles published before 2000 were considered outdated and were excluded.


RESULTS
Twenty-five articles met the inclusion criteria. Clinical presentation was non-specific. Histological examination only allowed for diagnosis. Lesions were locally or loco-regionally aggressive. Lymphatic or hematogenous metastasis were reported. No consensus about treatment was found. When surgery was used, it consisted in resection with safety margins ranging from 0.5 to 3cm depending on the teams. In case of metastasis, treatment consisted in chemo- and/or radiotherapy. A quarterly medical monitoring was recommended.


CONCLUSIONS
Malignant cutaneous adnexal tumors are rare. There is nowadays no treatment consensus. An initial staging by mean of a head and neck, chest, abdominal and pelvic CT-scan is mandatory. Treatment has to be decided in a multidisciplinary cancer committee. In the absence of metastasis, the reference treatment is surgical resection, possibly by Mohs micrographic technique, with large safety margins. In case of metastasis or if the loco-regional extension does not allow for a complete excision, chemotherapy and/or radiotherapy may be proposed. A close monitoring is essential.
Service de stomatologie, chirurgie maxillo-faciale et plastique, hôpital Nord, centre hospitalier des Bourrely, 13015 Marseille, France. Electronic address: maxromeu@hotmail.fr.
M
M
Romeu
Service de stomatologie, chirurgie maxillo-faciale et plastique, hôpital Nord, centre hospitalier des Bourrely, 13015 Marseille, France.
J M
JM
Foletti
Service de chirurgie maxillo-faciale, hôpital de la Conception, 13005 Marseille, France.
C
C
Chossegros
Service d'anatomie pathologique, hôpital Nord, centre hospitalier des Bourrely, 13015 Marseille, France.
J P
JP
Dales
Service dermatologie-vénéréologie, hôpital Nord, centre hospitalier des Bourrely, 13015 Marseille, France.
P
P
Berbis
Clinique dermatologique, faculté de médecine, université de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
B
B
Cribier
Service de stomatologie, chirurgie maxillo-faciale et plastique, hôpital Nord, centre hospitalier des Bourrely, 13015 Marseille, France.
L
L
Guyot
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018280:Carcinoma, Skin Appendage / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D005145:Face / Q000473:pathology; D005153:Facial Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006201:Hair Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D012535:Scalp / Q000473:pathology; D012878:Skin Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy
Anatomopathologie; Appendage skin carcinoma; Carcinome annexiel; Pathology; Therapeutics; Traitement