Aggressive Digital Papillary Adenoma /
Adenocarcinoma

Aggressive digital capillary adenocarcinoma is a rare cutaneous tumor of eccrine sweat gland origin that occurs on the plantar surfaces of the digits in the hand and foot. It can have an indolent clinical course without symptoms or change for years. Because of this, it may be misdiagnosed as a benign entity.

Excisional biopsy is recommended for indolent soft tissue masses on the plantar surfaces of the digits. Metastasis has been reported to occur in 14% of cases, with both widespread metastasis and frequent metastasis to the lungs. The usefulness of lymph node sampling has not been defined. No effective treatment is available for metastatic disease.

Aggressive surgical re-resection or amputation if necessary to avoid local recurrence. Aggressive surgical treatment is associated with a decrease in the rate of local recurrence from 50% to 5%.

Both the benign and a malignant variant of this tumor had been described, but a more recent review has cast doubt on the reliability of the histologic diagnosis. It appears that the histological features of this lesion do not allow for reliable differentiation between the benign and malignant forms, nor do the histological features allow for the distinction between tumors that have aggressive clinical course and metastasize from tumors that behave in a benign fashion.

Therefore, both digital capillary adenoma and digital capillary adenocarcinoma should be treated in similar fashion, and can be designated as aggressive digital capillary adenocarcinoma.

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