Evidence-Based Clinical Practice Guidelines for Microcystic Adnexal Carcinoma: Informed by a Systematic Review

Brandon Worley, Joshua L. Owen, Christopher A. Barker, Ramona Behshad, Christopher K. Bichakjian, Diana Bolotin, Jeremy S. Bordeaux, Scott Bradshaw, Todd V. Cartee, Sunandana Chandra, Nancy Cho, Jennifer Choi, M. Laurin Council, Daniel B. Eisen, Nicholas Golda, Conway C. Huang, Sherrif F. Ibrahim, S. I.Brian Jiang, John Kim, Mario LacutoureNaomi Lawrence, Erica H. Lee, Justin J. Leitenberger, Ian A. Maher, Margaret Mann, Kira Minkis, Bharat Mittal, Kishwer S. Nehal, Isaac Neuhaus, David M. Ozog, Brian Petersen, Faramarz Samie, Thuzar M. Shin, Joseph F. Sobanko, Ally Khan Somani, William G. Stebbins, J. Regan Thomas, Valencia Thomas, David Tse, Abigail Waldman, Y. Gloria Xu, Siegrid S. Yu, Nathalie C. Zeitouni, Tim Ramsay, Emily Poon, Alam Murad

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Importance: Microcystic adnexal carcinoma (MAC) occurs primarily in older adults of white race/ethnicity on sun-exposed skin of the head and neck. There are no formal guiding principles based on expert review of the evidence to assist clinicians in providing the highest-quality care for patients. Objective: To develop recommendations for the care of adults with MAC. Evidence Review: A systematic review of the literature (1990 to June 2018) was performed using MEDLINE, Embase, Web of Science, and the Cochrane Library. The keywords searched were microcystic adnexal carcinoma, sclerosing sweat gland carcinoma, sclerosing sweat duct carcinoma, syringomatous carcinoma, malignant syringoma, sweat gland carcinoma with syringomatous features, locally aggressive adnexal carcinoma, and combined adnexal tumor. A multidisciplinary expert committee critically evaluated the literature to create recommendations for clinical practice. Statistical analysis was used to estimate optimal surgical margins. Findings: In total, 55 studies met our inclusion criteria. The mean age of 1968 patients across the studies was 61.8 years; 54.1% were women. Recommendations were generated for diagnosis, treatment, and follow-up of MAC. There are 5 key findings of the expert committee based on the available evidence: (1) A suspect skin lesion requires a deep biopsy that includes subcutis. (2) MAC confined to the skin is best treated by surgery that examines the surrounding and deep edges of the tissue removed (Mohs micrographic surgery or complete circumferential peripheral and deep margin assessment). (3) Radiotherapy can be considered as an adjuvant for MAC at high risk for recurrence, surgically unresectable tumors, or patients who cannot have surgery for medical reasons. (4) Patients should be seen by a physician familiar with MAC every 6 to 12 months for the first 5 years after treatment. Patient education on photoprotection, periodic skin self-examination, postoperative healing, and the possible normal changes in local sensation (eg, initial hyperalgesia) should be considered. (5) There is limited evidence to guide the treatment of metastasis in MAC due to its rarity. Limitations of our findings are that the medical literature on MAC comprises only retrospective reviews and descriptions of individual patients and there are no controlled studies to guide management. Conclusions and Relevance: The presented clinical practice guidelines provide an outline for the diagnosis and management of MAC. Future efforts using multi-institutional registries may improve our understanding of the natural history of the disease in patients with lymph node or nerve involvement, the role of radiotherapy, and the treatment of metastatic MAC with drug therapy.

Original languageEnglish (US)
JournalJAMA dermatology
DOIs
StateAccepted/In press - Jan 1 2019

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Evidence-Based Practice
Practice Guidelines
Carcinoma
Sweat Glands
Skin
Radiotherapy
Syringoma
Library Science
Self-Examination
Mohs Surgery
Sweat
Quality of Health Care
Hyperalgesia
Solar System
Patient Education
Therapeutics
MEDLINE

ASJC Scopus subject areas

  • Dermatology

Cite this

Worley, B., Owen, J. L., Barker, C. A., Behshad, R., Bichakjian, C. K., Bolotin, D., ... Murad, A. (Accepted/In press). Evidence-Based Clinical Practice Guidelines for Microcystic Adnexal Carcinoma: Informed by a Systematic Review. JAMA dermatology. https://doi.org/10.1001/jamadermatol.2019.1251

Evidence-Based Clinical Practice Guidelines for Microcystic Adnexal Carcinoma : Informed by a Systematic Review. / Worley, Brandon; Owen, Joshua L.; Barker, Christopher A.; Behshad, Ramona; Bichakjian, Christopher K.; Bolotin, Diana; Bordeaux, Jeremy S.; Bradshaw, Scott; Cartee, Todd V.; Chandra, Sunandana; Cho, Nancy; Choi, Jennifer; Council, M. Laurin; Eisen, Daniel B.; Golda, Nicholas; Huang, Conway C.; Ibrahim, Sherrif F.; Jiang, S. I.Brian; Kim, John; Lacutoure, Mario; Lawrence, Naomi; Lee, Erica H.; Leitenberger, Justin J.; Maher, Ian A.; Mann, Margaret; Minkis, Kira; Mittal, Bharat; Nehal, Kishwer S.; Neuhaus, Isaac; Ozog, David M.; Petersen, Brian; Samie, Faramarz; Shin, Thuzar M.; Sobanko, Joseph F.; Somani, Ally Khan; Stebbins, William G.; Thomas, J. Regan; Thomas, Valencia; Tse, David; Waldman, Abigail; Xu, Y. Gloria; Yu, Siegrid S.; Zeitouni, Nathalie C.; Ramsay, Tim; Poon, Emily; Murad, Alam.

In: JAMA dermatology, 01.01.2019.

Research output: Contribution to journalArticle

Worley, B, Owen, JL, Barker, CA, Behshad, R, Bichakjian, CK, Bolotin, D, Bordeaux, JS, Bradshaw, S, Cartee, TV, Chandra, S, Cho, N, Choi, J, Council, ML, Eisen, DB, Golda, N, Huang, CC, Ibrahim, SF, Jiang, SIB, Kim, J, Lacutoure, M, Lawrence, N, Lee, EH, Leitenberger, JJ, Maher, IA, Mann, M, Minkis, K, Mittal, B, Nehal, KS, Neuhaus, I, Ozog, DM, Petersen, B, Samie, F, Shin, TM, Sobanko, JF, Somani, AK, Stebbins, WG, Thomas, JR, Thomas, V, Tse, D, Waldman, A, Xu, YG, Yu, SS, Zeitouni, NC, Ramsay, T, Poon, E & Murad, A 2019, 'Evidence-Based Clinical Practice Guidelines for Microcystic Adnexal Carcinoma: Informed by a Systematic Review', JAMA dermatology. https://doi.org/10.1001/jamadermatol.2019.1251
Worley, Brandon ; Owen, Joshua L. ; Barker, Christopher A. ; Behshad, Ramona ; Bichakjian, Christopher K. ; Bolotin, Diana ; Bordeaux, Jeremy S. ; Bradshaw, Scott ; Cartee, Todd V. ; Chandra, Sunandana ; Cho, Nancy ; Choi, Jennifer ; Council, M. Laurin ; Eisen, Daniel B. ; Golda, Nicholas ; Huang, Conway C. ; Ibrahim, Sherrif F. ; Jiang, S. I.Brian ; Kim, John ; Lacutoure, Mario ; Lawrence, Naomi ; Lee, Erica H. ; Leitenberger, Justin J. ; Maher, Ian A. ; Mann, Margaret ; Minkis, Kira ; Mittal, Bharat ; Nehal, Kishwer S. ; Neuhaus, Isaac ; Ozog, David M. ; Petersen, Brian ; Samie, Faramarz ; Shin, Thuzar M. ; Sobanko, Joseph F. ; Somani, Ally Khan ; Stebbins, William G. ; Thomas, J. Regan ; Thomas, Valencia ; Tse, David ; Waldman, Abigail ; Xu, Y. Gloria ; Yu, Siegrid S. ; Zeitouni, Nathalie C. ; Ramsay, Tim ; Poon, Emily ; Murad, Alam. / Evidence-Based Clinical Practice Guidelines for Microcystic Adnexal Carcinoma : Informed by a Systematic Review. In: JAMA dermatology. 2019.
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title = "Evidence-Based Clinical Practice Guidelines for Microcystic Adnexal Carcinoma: Informed by a Systematic Review",
abstract = "Importance: Microcystic adnexal carcinoma (MAC) occurs primarily in older adults of white race/ethnicity on sun-exposed skin of the head and neck. There are no formal guiding principles based on expert review of the evidence to assist clinicians in providing the highest-quality care for patients. Objective: To develop recommendations for the care of adults with MAC. Evidence Review: A systematic review of the literature (1990 to June 2018) was performed using MEDLINE, Embase, Web of Science, and the Cochrane Library. The keywords searched were microcystic adnexal carcinoma, sclerosing sweat gland carcinoma, sclerosing sweat duct carcinoma, syringomatous carcinoma, malignant syringoma, sweat gland carcinoma with syringomatous features, locally aggressive adnexal carcinoma, and combined adnexal tumor. A multidisciplinary expert committee critically evaluated the literature to create recommendations for clinical practice. Statistical analysis was used to estimate optimal surgical margins. Findings: In total, 55 studies met our inclusion criteria. The mean age of 1968 patients across the studies was 61.8 years; 54.1{\%} were women. Recommendations were generated for diagnosis, treatment, and follow-up of MAC. There are 5 key findings of the expert committee based on the available evidence: (1) A suspect skin lesion requires a deep biopsy that includes subcutis. (2) MAC confined to the skin is best treated by surgery that examines the surrounding and deep edges of the tissue removed (Mohs micrographic surgery or complete circumferential peripheral and deep margin assessment). (3) Radiotherapy can be considered as an adjuvant for MAC at high risk for recurrence, surgically unresectable tumors, or patients who cannot have surgery for medical reasons. (4) Patients should be seen by a physician familiar with MAC every 6 to 12 months for the first 5 years after treatment. Patient education on photoprotection, periodic skin self-examination, postoperative healing, and the possible normal changes in local sensation (eg, initial hyperalgesia) should be considered. (5) There is limited evidence to guide the treatment of metastasis in MAC due to its rarity. Limitations of our findings are that the medical literature on MAC comprises only retrospective reviews and descriptions of individual patients and there are no controlled studies to guide management. Conclusions and Relevance: The presented clinical practice guidelines provide an outline for the diagnosis and management of MAC. Future efforts using multi-institutional registries may improve our understanding of the natural history of the disease in patients with lymph node or nerve involvement, the role of radiotherapy, and the treatment of metastatic MAC with drug therapy.",
author = "Brandon Worley and Owen, {Joshua L.} and Barker, {Christopher A.} and Ramona Behshad and Bichakjian, {Christopher K.} and Diana Bolotin and Bordeaux, {Jeremy S.} and Scott Bradshaw and Cartee, {Todd V.} and Sunandana Chandra and Nancy Cho and Jennifer Choi and Council, {M. Laurin} and Eisen, {Daniel B.} and Nicholas Golda and Huang, {Conway C.} and Ibrahim, {Sherrif F.} and Jiang, {S. I.Brian} and John Kim and Mario Lacutoure and Naomi Lawrence and Lee, {Erica H.} and Leitenberger, {Justin J.} and Maher, {Ian A.} and Margaret Mann and Kira Minkis and Bharat Mittal and Nehal, {Kishwer S.} and Isaac Neuhaus and Ozog, {David M.} and Brian Petersen and Faramarz Samie and Shin, {Thuzar M.} and Sobanko, {Joseph F.} and Somani, {Ally Khan} and Stebbins, {William G.} and Thomas, {J. Regan} and Valencia Thomas and David Tse and Abigail Waldman and Xu, {Y. Gloria} and Yu, {Siegrid S.} and Zeitouni, {Nathalie C.} and Tim Ramsay and Emily Poon and Alam Murad",
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TY - JOUR

T1 - Evidence-Based Clinical Practice Guidelines for Microcystic Adnexal Carcinoma

T2 - Informed by a Systematic Review

AU - Worley, Brandon

AU - Owen, Joshua L.

AU - Barker, Christopher A.

AU - Behshad, Ramona

AU - Bichakjian, Christopher K.

AU - Bolotin, Diana

AU - Bordeaux, Jeremy S.

AU - Bradshaw, Scott

AU - Cartee, Todd V.

AU - Chandra, Sunandana

AU - Cho, Nancy

AU - Choi, Jennifer

AU - Council, M. Laurin

AU - Eisen, Daniel B.

AU - Golda, Nicholas

AU - Huang, Conway C.

AU - Ibrahim, Sherrif F.

AU - Jiang, S. I.Brian

AU - Kim, John

AU - Lacutoure, Mario

AU - Lawrence, Naomi

AU - Lee, Erica H.

AU - Leitenberger, Justin J.

AU - Maher, Ian A.

AU - Mann, Margaret

AU - Minkis, Kira

AU - Mittal, Bharat

AU - Nehal, Kishwer S.

AU - Neuhaus, Isaac

AU - Ozog, David M.

AU - Petersen, Brian

AU - Samie, Faramarz

AU - Shin, Thuzar M.

AU - Sobanko, Joseph F.

AU - Somani, Ally Khan

AU - Stebbins, William G.

AU - Thomas, J. Regan

AU - Thomas, Valencia

AU - Tse, David

AU - Waldman, Abigail

AU - Xu, Y. Gloria

AU - Yu, Siegrid S.

AU - Zeitouni, Nathalie C.

AU - Ramsay, Tim

AU - Poon, Emily

AU - Murad, Alam

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Importance: Microcystic adnexal carcinoma (MAC) occurs primarily in older adults of white race/ethnicity on sun-exposed skin of the head and neck. There are no formal guiding principles based on expert review of the evidence to assist clinicians in providing the highest-quality care for patients. Objective: To develop recommendations for the care of adults with MAC. Evidence Review: A systematic review of the literature (1990 to June 2018) was performed using MEDLINE, Embase, Web of Science, and the Cochrane Library. The keywords searched were microcystic adnexal carcinoma, sclerosing sweat gland carcinoma, sclerosing sweat duct carcinoma, syringomatous carcinoma, malignant syringoma, sweat gland carcinoma with syringomatous features, locally aggressive adnexal carcinoma, and combined adnexal tumor. A multidisciplinary expert committee critically evaluated the literature to create recommendations for clinical practice. Statistical analysis was used to estimate optimal surgical margins. Findings: In total, 55 studies met our inclusion criteria. The mean age of 1968 patients across the studies was 61.8 years; 54.1% were women. Recommendations were generated for diagnosis, treatment, and follow-up of MAC. There are 5 key findings of the expert committee based on the available evidence: (1) A suspect skin lesion requires a deep biopsy that includes subcutis. (2) MAC confined to the skin is best treated by surgery that examines the surrounding and deep edges of the tissue removed (Mohs micrographic surgery or complete circumferential peripheral and deep margin assessment). (3) Radiotherapy can be considered as an adjuvant for MAC at high risk for recurrence, surgically unresectable tumors, or patients who cannot have surgery for medical reasons. (4) Patients should be seen by a physician familiar with MAC every 6 to 12 months for the first 5 years after treatment. Patient education on photoprotection, periodic skin self-examination, postoperative healing, and the possible normal changes in local sensation (eg, initial hyperalgesia) should be considered. (5) There is limited evidence to guide the treatment of metastasis in MAC due to its rarity. Limitations of our findings are that the medical literature on MAC comprises only retrospective reviews and descriptions of individual patients and there are no controlled studies to guide management. Conclusions and Relevance: The presented clinical practice guidelines provide an outline for the diagnosis and management of MAC. Future efforts using multi-institutional registries may improve our understanding of the natural history of the disease in patients with lymph node or nerve involvement, the role of radiotherapy, and the treatment of metastatic MAC with drug therapy.

AB - Importance: Microcystic adnexal carcinoma (MAC) occurs primarily in older adults of white race/ethnicity on sun-exposed skin of the head and neck. There are no formal guiding principles based on expert review of the evidence to assist clinicians in providing the highest-quality care for patients. Objective: To develop recommendations for the care of adults with MAC. Evidence Review: A systematic review of the literature (1990 to June 2018) was performed using MEDLINE, Embase, Web of Science, and the Cochrane Library. The keywords searched were microcystic adnexal carcinoma, sclerosing sweat gland carcinoma, sclerosing sweat duct carcinoma, syringomatous carcinoma, malignant syringoma, sweat gland carcinoma with syringomatous features, locally aggressive adnexal carcinoma, and combined adnexal tumor. A multidisciplinary expert committee critically evaluated the literature to create recommendations for clinical practice. Statistical analysis was used to estimate optimal surgical margins. Findings: In total, 55 studies met our inclusion criteria. The mean age of 1968 patients across the studies was 61.8 years; 54.1% were women. Recommendations were generated for diagnosis, treatment, and follow-up of MAC. There are 5 key findings of the expert committee based on the available evidence: (1) A suspect skin lesion requires a deep biopsy that includes subcutis. (2) MAC confined to the skin is best treated by surgery that examines the surrounding and deep edges of the tissue removed (Mohs micrographic surgery or complete circumferential peripheral and deep margin assessment). (3) Radiotherapy can be considered as an adjuvant for MAC at high risk for recurrence, surgically unresectable tumors, or patients who cannot have surgery for medical reasons. (4) Patients should be seen by a physician familiar with MAC every 6 to 12 months for the first 5 years after treatment. Patient education on photoprotection, periodic skin self-examination, postoperative healing, and the possible normal changes in local sensation (eg, initial hyperalgesia) should be considered. (5) There is limited evidence to guide the treatment of metastasis in MAC due to its rarity. Limitations of our findings are that the medical literature on MAC comprises only retrospective reviews and descriptions of individual patients and there are no controlled studies to guide management. Conclusions and Relevance: The presented clinical practice guidelines provide an outline for the diagnosis and management of MAC. Future efforts using multi-institutional registries may improve our understanding of the natural history of the disease in patients with lymph node or nerve involvement, the role of radiotherapy, and the treatment of metastatic MAC with drug therapy.

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