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Sebaceous Carcinoma: Small, pink bump on the cheek of a 68 year-old man. An early lesion like this is easily curable with very low recurrence rate.
77 year-old man with eroded, yellow lesion on the upper lip. This is an unusal location for a sebaceous carcinoma to develop.
Sebaceous Carcinoma

Sebaceous Carcinoma is 


Small yellow islands of tumor of the conjunctiva of the lower eyelid in a 46 year-old woman. Because this sebaceous carcinoma was localized and did not spread far from the visible tumor, it was easily cleared with Mohs surgery. 
Recurrent sebaceous carcinoma of the eyelid in an 85 year-old woman, diffusely spreading over the upper and lower lids.
Microcystic Adnexal Carcinoma

Microcystic Adnexal Carcinoma (MAC) is a rare form of skin cancer that arises from the duct of the sweat gland. It appears most often in middle-aged people, but has been seen in children and the elderly as well. Women are slightly more affected. The tumor arises most often on the face, around the lips and central cheeks near the nose. It begins as a small pearly bump that can mimic basal cell carcinoma. Although MAC grows slowly, the tumor can reach very large sizes and invade deeply into subcutaneous tissues including the fat, muscle, and bone, resulting in signficant morbidity and disfigurement. MAC rarely metastasizes (spreads internally through lymph nodes or blood stream), and death is rare. MAC shows a definite tendency to significant sub-clinical spread, meaning that very often there is much more tumor under and around the visible tumor than can be appreciated with the eye. Because of this, MAC can be very difficult to cure with standard surgical techniques, with multiple surgical episodes necessary to clear the tumor, and a high recurrence rate. In contrast, Mohs micrographic surgery is very effective in tracing out the subclinical roots of the tumor. Mohs is now considered the treatment of choice for microcystic adnexal carcinoma. 
   Microcystic Adnexal Carcinoma on the cheek of a 17 year-old. It resembles a basal cell carcinoma.


Merkel Cell Carcinoma

Merkel Cell Carcinoma (MCC), also known as neuroendocrine carcinoma of the skin, is a very aggressive cancer. It is rare, with around 1400 new cases per year in the US.  MCC is a cancer of older adults with a history of significant sun exposure.  It has recently been linked to a virus (Merkel cell polyomavirus) that most adults have been exposed to during their lifetimes.  It is thought that an interaction of the viral DNA and ultraviolet light from the sun can lead to formation of this cancer later in life.  Patients with Merkel cell carcinoma are not contagious.  Due to the rarity of MCC, no large studies have been performed, and no clear treatment guidelines have been developed for this malignancy.  MCC can appear as a pink bump on the skin that grows quickly to form a red, bleeding mass. Treatment includes excision of the skin tumor by Mohs micrographic surgery or wide excision.  Radiation therapy is often added, although a definite benefit has not been proved.  Prognosis depends on the stage of the disease at the time of diagnosis.  Small tumors (<2 cm) removed surgically before metastasis can be cured in up to 90% of patients.  If the MCC has already metastasized, the prognosis is very poor.

Merkel Cell Carcinoma on the upper calf of a 92 year-old man.