Primary mucinous carcinoma (PMC)
of the skin—a case report
Nau’shil Kaur Randhawa
Marcus T. C. Wong
Received: 20 February 2009 / Accepted: 30 June 2009 / Published online: 5 August 2009
Abstract Primary mucinous carcinoma of the skin is a rare
malignant adnexal neoplasm. It was first described by
Lennox et al. in 1952. It is uncertain whether it is of
apocrine or eccrine origin (Wright and Font, Cancer
44:1757–1768, 2; Mendoza and Helwig, Arch Dermatol
103:68–78, 3). Showing morphological similarity to mu-
cinous carcinoma of the breast, it may be difficult to
distinguish it from a cutaneous metastatic deposit of
mucinous adenocarcinoma from a visceral primary lesion.
Hence, it deserves attention not only for its scarcity but also
for the challenge in determining its precise diagnosis and
hence, planning its management. We present a case of
primary mucinous carcinoma of the skin.
Keywords Primary mucinous carcinoma of the skin
A 47-year-old Chinese gentleman presented with a 1-year
history of a left cheek lump. Upon physical examination,
the lesion was a skin-coloured, dome-shaped nodule
measuring 2 cm in diameter. At excision, what was
suspected to be an epidermal cyst was excised completely.
Histology showed a circumscribed, non-encapsulated
nodule of mucinous carcinoma extending to the resection
margins. There were abundant mucin pools in which
clusters of relatively bland epithelial cells arranged in solid,
cribriform and micropapillary patterns were seen. Occa-
sional mitoses were seen.
Differential diagnosis was that of metastatic mucinous
carcinoma. As most cases of mucinous carcinoma of the
skin are noted to be metastatic from another site [1, 8, 9]
such as salivary and lacrimal glands, gastrointestinal tract,
nose and paranasal sinuses, bronchi and renal pelvis
amongst other sites, investigations were initiated in search
of a primary tumour.
A CT scan of the neck, posterior nasal space and salivary
glands was performed. A left premaxillary soft tissue
thickening not involving the maxilla was reported, which
correlated with expected post-operative tissue swelling. A
CT of the thorax, abdomen and pelvis was done, showing a
non-specific left adrenal gland thickening with no other
In addition, the patient underwent a positron emission
tomography CT whole body scan, which showed a small,
metabolically hypo-active left adrenal nodule, which was
considered non-specific and indeterminate. There was no
evidence of FDG avid abnormality anywhere in the body to
suggest presence of metabolically active primary or
secondary neoplasm. As such, the diagnosis of primary
mucinous carcinoma of the left cheek was made.
The surgical plan was that of a wide excision and free
radial forearm flap. Due to financial reasons, the patient
decided against surgery and opted for regular surveillance
despite medical advice.
Primary mucinous carcinoma of the skin is a rare entity.
Since 1952, only about 200 cases have been documented as
N. K. Randhawa (*)
M. T. C. Wong
Section of Plastic, Reconstructive and Aesthetic Surgery,
Department of General Surgery, Tan Tock Seng Hospital,
Eur J Plast Surg (2009) 32:315–317