Sebaceous carcinoma of the axilla : A rare cutaneous maligna
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This was a case of a 31-year-old male with a 10-year history of a right axillary mass. The lesion initially began as a 0.5 cm mass on the right axilla noted to be fixed, erythematous, non-tender and notably irregularly shaped. In the interim, the condition was just tolerated. Progression of the growing axillary mass prompted consulting at the outpatient department. The irregularly shaped mass was already noted to be 10 cm at its largest diameter. An incisional biopsy was done, which revealed sebaceous carcinoma. The patient was advised for surgery.

The patient was averagely built with normal systemic examination findings. On the right axilla, he had a 10 × 6 cm irregularly shaped mass still noted to be erythematous and non-tender. There were no palpable axillary lymph nodes. Bilateral breasts and the contralateral axilla were unremarkable. Wide excision of the right axillary mass with a frozen section of the margins was done under general anesthesia. A frozen section was done in order to guarantee disease-free margins. This consequently left a full-thickness defect around 15 × 30 cm on the right axilla. A parascapular fasciocutaneous flap coverage was subsequently done on the defect. The patient was then discharged improved on the fourth postoperative day and was advised surveillance follow-up as per outpatient basis.

On pathologic gross inspection of the mass, it consisted of skin covered with fibrofatty tissue and was measured to be 19.5 × 10 × 4.5 cm. On sectioning, there was a well-circumscribed pale, tan, and rubbery mass, 10 × 6.5 × 6 cm, with areas of hemorrhage and was located 0.3 cm from the nearest basal margins. The microscopic examination of the mass showed sections of malignant neoplasm composed of sheets of highly pleomorphic cells with abundant pale, vacuolated, and fluffy appearing cytoplasm with distinct borders and small to large vesicular nuclei with prominent nucleoli, while some nuclei appeared pyknotic. The surrounding stroma was fibrous, with heavy mononuclear infiltration. The neoplasm showed infiltrative borders. Sections of the skin were free of tumor. No epidermal tissue was seen in continuity with the tumor. There was no clefting between the stroma and the neoplastic cells. The final biopsy of the mass revealed poorly differentiated sebaceous carcinoma with all surgical margins negative for tumor; furthermore, two axillary lymph nodes were negative for tumor metastasis.