A 67-year old female presented with a smooth, solitary lump on scalp in the right occipital region (Figure ).\nOn examination, a 3 x 3 cm smooth, firm, non-mobile lump was palpable with overlying scalp hair. The initial impression was that of a sebaceous cyst and she was advised to wait and watch for any changes to the features of the lesion or development of any new symptoms. On review after six months, the size of the lesion increased to 4 x 4 cm and the patient reported progressively worsening itching on the overlying skin. A decision was made to completely excise the cyst. Histopathological analysis from the lesion confirmed a mucinous eccrine carcinoma of skin (Figures , ).
A 40-year-old male consulted MDACC with a history of thickening of the left medial lower eyelid and enlargement of a caruncle. A CT scan of orbits and head and neck soft tissue demonstrated an enhancing and infiltrative mass along the inferomedial aspect of the left anterior orbit () and no evidence of facial or cervical lymphadenopathy. PET/CT scan performed in an outside facility did not detect second primary malignancy or metastatic disease. Radical surgical resection of the left orbital, eyelid, and lacrimal sac mass with intraoperative assessment of margins was performed. Grossly, the specimen measured 4.0 × 3.5 cm. Histopathologically, neoplastic cells forming a mass lesion adjacent to the punctum and infiltrating caruncle was seen (). Cords of pleomorphic cells with histiocytoid appearance infiltrating connective tissue and depicting vesicular nuclei, large nucleoli, and eosinophilic cytoplasm with intracytoplasmic vacuolization were identified ( inset). Perineural invasion was present. The patient underwent proton therapy and chemotherapy. Thirteen months after treatment, the patient had a left neck dissection with metastatic adenocarcinoma to two of six lymph nodes at level III.