Challenges in Diagnosis and Management of Spiradenocarcinoma: A Case Report

Spiradenocarcinoma is a rare skin adnexal neoplasm that may behave aggressively. It is often associated with a benign slow-growing spiradenoma that has undergone malignant transformation, characterised by rapid growth and tenderness. They often present as solitary skin nodules and are classified as low-grade or high-grade tumors. We report a case of a high-grade spiradenocarcinoma in association with a benign spiradenoma, measuring 3.2 x 3 x 2.8 cm, situated on the chest wall of a 63-year-old male. The lesion had been enlarging over 20 years but recently became painful, prompting treatment. Preoperative ultrasound revealed a complex vascular lesion suggestive of a dermoid cyst. Excision of the tumor under general anaesthesia was performed. Histopathology confirmed a high-grade spiradenocarcinoma cleared of margins by 1 mm. Wide local excision of the scar, with a 1 cm margin, confirmed no further malignancy. An FDG PET-CT showed no evidence of distant metastases. The patient recovered well and has had no evidence of tumor recurrence at the 3-month follow-up. Given the rarity of this neoplasm and the paucity of cases in the literature, there is a lack of consensus on treatment. In most cases, surgical excision with adequate margins is the mainstay of treatment, with lymph node dissection reserved for those with suspected or confirmed lymph node metastases.