Acta Dermato-Venereologica 98-10CompleteContent | Page 22
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SHORT COMMUNICATION
Eccrine Porocarcinoma of the Skin is Rising in Incidence in the East of England
Peter K. C. GOON 1 , Puran GURUNG 1 , Nick J. LEVELL 1 , Priya SUBRAMANIAN 1 , Adrian S. W. YONG 4 , Kevin Y. C. LEE 1 , Laszlo
IGALI 2 , David GREENBERG 3 , Syed N. SHAH 1 and Eunice K. H. TAN 1
Departments of 1 Dermatology and 2 Cellular Pathology, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, 3 Public
Health England National Cancer Registration and Analysis Service, Fulbourn, Cambridge, UK, and 4 Department of Medicine, University of
Malaya, Faculty of Medicine, Unit of Dermatology, Kuala Lumpur, West Malaysia. E-mail: [email protected]
Accepted Jun 26, 2018 Epub ahead of print Jun 29, 2018
Eccrine porocarcinoma (EPC) was first described by
Pinkus & Mehregan in 1963 (1) as “epidermotropic
eccrine carcinoma” and is the malignant counterpart
of eccrine poroma. It is a rare tumour (0.005–0.01%
(2, 3) of cutaneous tumours), thought to arise from the
acrosyringium of the sweat gland of the skin. The term
“porocarcinoma” was first used by Mishima & Morioka
in 1969 (4). Although initial case series suggested that
this was a highly aggressive tumour, with approximately
60% of cases reported to have local recurrence, metas-
tases or death, later larger case series of 18, 24 and 27
patients, respectively, did not support such an aggressive
natural history (3, 5, 6)
The largest case series to date (69 cases) in 2001 (7),
reported EPC as a less aggressive tumour, with 17% local
recurrence, 19% lymph node metastasis and 11% distant
metastases or death.
This study analysed the age-standardised incidence
rates for the population of the East of England (East Nor-
folk and Waveney), and estimated the numbers of cases
likely to be found here and in the UK for 2020, 2025 and
2030. This cohort (n = 152) is the largest reported so far
and there are long-term follow-up data for recurrences,
metastases and survival/death, thus helping to clarify the
natural history of this tumour.
excluded from analyses. Only patients with verified survival and
recurrence data were included in the study.
Statistical analyses were performed using statistics package
GraphPad™ Prism 7 (2016).
RESULTS
Over the 10-year study period stated above, the popula-
tion of ENW increased by approximately 10.4% at a
steady rate (8–11). Our recorded data for the numbers of
EPC from the study period are shown in Fig. 1. Based on
these data, linear regression analyses estimate numbers
of cases for the years 2,020 (n = 54), 2,025 (n = 71) and
2,030 (n = 88).
The East of England has a higher number of the el-
derly (> 65 years of age), Caucasians (White) and more
sunshine per annum by comparison with the UK mean.
The technique of approximation to the means (8–10)
controlled for these risk factors and extrapolated regional
ENW data to UK levels, this allowed estimation of the
national incidence in future years.
The predicted total number of cases of EPC for the
whole of the UK was 2,979 in 2020, 3,873 in 2025 and
4,746 in 2030. [These figures are calculated estimates
only, and the risk of error increases the further away the
estimate is made (see Fig. 1)].
METHODS
Electronic databases from the pathology department at the Norfolk
and Norwich University Hospital (NNUH) from East Norfolk
and Waveney (ENW): (Breckland, Broadland, Great Yarmouth,
North Norfolk, Norwich, South Norfolk and Waveney community
districts) in the Eastern Region of the UK (population: 794,043 in
2004 increasing to 870,100 in 2013) (8–11), were analysed and
collected from the 1 st of January, 2004 to 31 st December 2013 for
this retrospective cohort analyses.
Skin cancer histology results from each hospital in the region
are coded and recorded monthly by the International Classification
of Diseases categories ICD10/ICDO-2.
There have been no changes in catchment area for the pathology
laboratory or change in practice protocols or routines for the pa
thologists and laboratory involved for the period of study. There
have been no changes in physician patterns of referral of lesions
over the study period. Standard immunohistochemical stains for
markers known to be helpful in diagnosis of EPC such as epithelial
membrane antigen (EMA), carcino-embryonic antigen (CEA),
CD117 (KIT), etc, have been used as required or as available.
Specialist dermatopathologists in the NNUH led the routine ana-
lyses of skin specimens. All porocarcinoma in situ samples were
Fig. 1. Number of cases of eccrine porocarcinoma diagnosed in
East Norfolk and Waveney, with predicted cases in 2020, 2025 and
2030. Total no. of cases per year were 1, 5, 5, 11, 14, 13, 14, 31, 28, 30
for the data points shown below from 2004–2013.
This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta
Journal Compilation © 2018 Acta Dermato-Venereologica.
doi: 10.2340/00015555-3000
Acta Derm Venereol 2018; 98: 991–992