SKINIPEDIA - Skin Encyclopedia: Epidermoid Carcinoma
Epidermoid Carcinoma Occurring in Acne Conglobata by
John S. Dillon, M.D., Harlan J. Spjut, M.D.
Source: the Departments of Surgery and Surgical Pathology, Washington University School of Medicine, and Barnes Hospital, St. Louiis, Mlissouiri
DISCUSSION
Infections, intracutaneous sinuses and
fistulae, septicemia and, rarely, epidermoid
carcinoma complicate acne seu conglobata.
The pathogenesis of the carcinomas may
be related to the chronic inflammation, a
situation analogous to that of epidermoid
carcinomas arising in the sinuses of chronic
osteomyelitis. These carcinomas and those
that occur in acne seu conglobata are usually
well differentiated, slow growing and
slow to metastasize. In fact, of the known
carcinomas arising in acne seu conglobata
none have had demonstrable metastases.
One of our patients (G. B.) and another
previously reported received radiation for
treatment of acne. The intervals from exposure
to diagnosis of cancer were seven
years and two months respectively. These
are shorter than usually seen in radiation
induced skin cancers. It is consequently
unlikely that radiation was the primary
cause of these cancers.
Both of our patients have had three
carcinomas. The question arises whether
the later lesions were primaries or persistences.
We are inclined to believe that the
later lesions are new primaries for the following
reasons:
1) in all excisions, no tumor
was found at the lines of resection;
2) the
lesions were widely separated; and
3) the
interval of time between the excision of
the first and the appearance of the second
tumors was seven years (F. B.) and four
years (G. B.).
The treatment of the two mie was simllilar:
wide resection of the tumor and surrounding
tissue first, followed some years
later by a more extensive resection for
cancers wvhich wvere probably new primaries.
It would seem that the most logical
treatment of these carcinomas would be
preventive. Elimination of the draining
sinuses and involved skin in those areas
which have shown a propensity for developing
carcinoma, that is, buttocks, perineum,
and sacral regions, by wide excision
and skin grafting before carcinoma develops
should be effective.
SUMMARY
Two patients with acne conglobata, complicated
by epidermoid carcinomas, are reported.
Both are believed to have three
independent carcinomas.
Treatment in both cases consisted of
wide resection followed by perineal resection
four and seven vears later.
All known cases of epidermoid carcinomas
arising in areas of acne conglobata
have occurred in the same region-sacrum,
buttocks, or perineum. None have metastasized
to regional lymph nodes, or distally.
References
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St. Louis, C. V. Mosby, p. 171, 1962.
2. Hellier, F. F.: A Familial Case of Acne Vulgaris
with Lesions Suggesting a Relationship
to Acne Conglobata. Brit. J. Dermatol. &
Syph., 51:109, 1939.
3. Lang, E.: Hautkrankheiten, Wiesbaden, J. F.
Bergman, p. 504, 1902.
4. MIichelson, H. E. and P. K. Allen: Acne Conglobata.
Arch. Dermatol. & Syph., 23:49,
1931.
5. Reitmann, K.: Acne Aggregata Seu Conglobata.
Arch. f. Dermatol. u. Syph., 90:249, 1908.
6. Schiff, B. and A. B. Kern: Carcinoma Developing
in Chronic Acne Conglobata. Arch.
Dermatol., 75:879, 1957.
7. Selisky, A. B.: Zur Histologie Acne Conglobata.
Arch. f. Dermatol. u. Syph., 158:460,
1929.
8. Spitzer, L.: Dermatitis Follicularis et Perifollicularis
Conglobata.
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