Abstract:

Porocarcinoma is a malignancy representing 0.005 0.01% of all cutaneous tumors. This malignant tumor often mimics other less aggressive tumors, leading to misdiagnosis and worse patient outcomes. Due to its rarity, hitopathologic features that predict the tumor behavior remain unclear. A retrospective chart and slide review was conducted of all cases of porocarcinomas from 1/2015 through 2/2020 at a tertiary referral center. Eighteen patients were identified. Most patients were male (55.6%), white (72.2%) and presented at a mean age of 63.3 years, range 46-89. The most common initial presentation was a nodule (66.7%) on the scalp (50%). The average clinical size of the lesions was 2.1 cm. Diagnosis was an average of 34.6 months after initial disease onset. Four patients had metastases at diagnosis (3 nodal and 1 distant). Five patients had disease-free survival, 3 disease-free before lost to follow up (FU) and 2 immediately lost to FU. There were 5 recurrences and 3 deaths. Sixteen patients (89%) had slides available for histological evaluation with a total of 25 specimens, 11 of them were biopsies and 14 were resections. The most common histological pattern was squamoid (84%) and the most common growth pattern was infiltrative (60%). The average tumor thickness was 6.9 mm (median 4.8 mm). Lymphovascular and perineural invasion were present in 4 and 5 specimens, respectively. Necrosis was present only in 8 specimens. Immunohistochemical stains were used on 10 specimens with CEA being the most common. Our study provides a detailed analysis of the clinical and histologic features of porocarcinoma and treatment practices. These data help characterize current porocarcinoma diagnosis and management at a depth previously not well-described. Having a standardized histologic evaluation and management is crucial to improve our understanding of this disease and optimize patient care. Herein, we attempt to take a step toward this goal.

Financial Disclosure:
No current or relevant financial relationships exist.

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Ahmad Aleisa, MD