Recurrent Eccrine Syringomatous Carcinoma in the First Web Space of the Hand: A Rare Case

Background: Carcinoma of the sweat glands of the hand is an extremely rare dermal neoplasm that is difficult to clinically and histologically diagnose. However, because of its potential for rapid growth and metastasis, early recognition may allow more timely treatment. Only five cases of this rare adnexal tumor have been reported outside the head and neck area: on the buttock, perianal skin, hand, and axilla. We present a case of eccrine syringomatous carcinoma in the first web space of the hand. Aim and Objectives: To describe the early diagnosis of a rare type of malignant skin tumor using clinical and histological analyses, and to describe optimal web space reconstruction after wide excision of tumor. Materials and Methods: A 62-year-old woman, who had been treated elsewhere with a wide excision of the tumor and full-thickness skin graft repair for a left-hand first web space papillary carcinoma in 2004, presented with a third recurrence of her tumor in December 2006. A skin biopsy showed recurrent eccrine syringomatous carcinoma. A wide excision of the tumor with pedicled reverse radial forearm flap reconstruction was done in January 2007. Results: There was no necrosis on the flap, no donor site comorbidity, and no tumor recurrence at a 30-month follow-up. Good functional results were also obtained. Conclusion: Eccrine syringomatous carcinoma is an exceedingly rare cutaneous tumor that requires an experienced pathologist for an accurate diagnosis. An initially incorrect diagnosis may lead to the wrong operative plan, which may cause this invasive skin tumor to locally recur or even metastasize.