Sweat-gland Tumours: A Clinical Review of Cases in One Centre Over 20 Years

Hall, J.; Knee, G.; A'Hern, R.P.; Clarke, J.; Glees, J.P.; Ford, H.T.; Eeles, R.A.

doi:10.1016/j.clon.2005.12.011

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Volume 18, Issue 4 , Pages 351-359, May 2006

Sweat-gland Tumours: A Clinical Review of Cases in One Centre Over 20 Years

J. Hall
- Royal Marsden NHS Foundation Trust, London, UK
G. Knee
- Kingston Hospital, Surrey, UK
R.P. A'Hern
- Royal Marsden NHS Foundation Trust, London, UK
J. Clarke
- Belvoir Park Hospital, Belfast, N. Ireland
J.P. Glees
- Royal Marsden NHS Foundation Trust, London, UK
- St George's NHS Trust, London, UK
H.T. Ford
- Royal Marsden NHS Foundation Trust, London, UK
- Since completion of this paper, but prior to submission, Dr Ford sadly died. This paper is dedicated to his memory.
R.A. Eeles
- Royal Marsden NHS Foundation Trust, London, UK
- St George's NHS Trust, London, UK
- Institute of Cancer Research, London, UK
- Author for correspondence: Dr R. A. Eeles, Reader in Clinical Cancer Genetics and Honorary Consultant in Cancer Genetics and Clinical Oncology, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK. Tel: +44-20-8661-3642; Fax: +44-20-8770-1489.

Received 20 July 2005; received in revised form 7 November 2005; accepted 19 December 2005.

Abstract

Aims

Sweat-gland tumours (SGTs) are uncommon, but malignant varieties are very rare. We have added our data on 30 new cases seen at the Royal Marsden NHS Foundation Trust to the published literature, particularly concentrating on clinical issues. We include a literature review.

Materials and methods

The Royal Marsden NHS Foundation Trust database was searched for cases of SGT from 1972. Data were collected on all cases, including patient demographics and tumour characteristics, treatment and outcome.

Results

Thirty cases were confirmed histologically to be SGTs. Fourteen were malignant, 15 benign and the degree of malignancy in one was histologically indistinguishable. Mean age was 55 years (64 for malignant, 47 for benign tumours). The 15 patients with benign tumours were almost all treated with complete excision. Those with local relapse underwent successful re-excision. Their 5-year disease-free survival was 78% and cause-specific survival was 100%. Twelve of the 14 malignant tumours had localised disease at diagnosis, one had nodal disease and one had metastatic tumour nodules. All except one were treated with wide local excision. The patient with nodal involvement also had a lymph-node dissection. Two received adjuvant radiotherapy to the tumour bed. One received a melphalan limb perfusion. Eight of the 14 had no relapse. Six had locoregional relapse, and four of these also developed distant metastases. Visceral disease was always fatal. Radiotherapy and chemotherapy at relapse were unsuccessful. Five-year disease-free survival was 45%, and cause-specific survival was 57%.

Conclusion

These rare tumours should be treated initially with complete wide local excision. In malignant tumours, lymph-node involvement is a poor prognostic sign. Wide local excision remains the primary treatment. Adjuvant radiotherapy may be useful in high-risk cases.

Key words: Natural history, outcomes, sweat-gland carcinoma, sweat-gland tumour, treatment