Eyelid Microcystic Adnexal Carcinoma

1. Hui-Chuan Kau¹
2. Chieh-Chih Tsai²

¹Department of Ophthalmology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei 112, Taiwan
²Department of Ophthalmology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei 112, Taiwan

Introduction: Microcystic adnexal carcinoma is a rare malignant skin tumor with follicular and sweat gland differentiation. This tumor has a predilection for the central facial region, most often occurring at the nasolabial fold, lips or cheek. Periocular involvement is uncommon. We report one case of eyelid microcystic adnexal carcinoma receiving wide excision with margin control and eyelid reconstruction.

Methods: Observational case report.

Results: A 54-year-old man claimed to have an indurated nodule over the margin of left lower central eyelid for more than 10 years, and whitish discoloration with thickening of the eyelid margin adjacent to the nodule with slow progression for 2 years. He had excisional biopsy of the indurated nodule in other hospital and was diagnosed as basal cell carcinoma. However, the pathological diagnosis of the original surgical block by other pathologists was trichoepithelioma. A re-biopsy on the whole layer of the residual eyelid lesion was done, which revised the previous diagnosis to be microcystic adnexal carcinoma. The patient then received wide excision with margin control by frozen section and eyelid reconstruction.

Conclusions: The clinical and histological diagnosis of microcystic adnexal carcinoma is difficult for both ophthalmologists and pathologists. The tumor is benign in appearance and slowly growing, but locally aggressive and deeply infiltrative with high recurrence rate. The initial biopsy must be large and deep enough for correct diagnosis. Complete excision with margin control is essential for preventing recurrence.