Thirty-six cases of sweat gland carcinoma excluding extramammary Paget's disease were clinically analyzed. The patients were diagnosed and treated in our department from 1996 to 2015. They included 18 males and 18 females with an average age of 68 years (range 29-91 years). The primary lesion was located in the trunk in 15 patients, the foot in 7 patients, the lower extremities in 6 patients, and other places in 8 patients. Lymphnode metastasis was observed in 15 patients and distant metastasis in 9 patients, all of whom died of the disease.
Because of the rarity and the histological diversity in malignant sweat gland tumors, there is no established histological classification nor standard treatment. A prospective multicenter study is warranted.
Coccygeal pad is a densely collagenous lesion arising in the sacrococcygeal area with unclarified etiology. We report a case of a 20-year-old man with a 60×30 mm, pink nodule in his coccygeal region. He had noticed the lesion 5 years previously, although the skin-colored protrusion in the coccygeal region had been observed by his mother since birth. Imaging studies including X-ray radiography and CT scans of the pelvis revealed that the coccyx was sharply angulated forward between the first and second segments, almost perpendicular to the axis. Furthermore, the lower half of the sacrum showed a straight line without the posteriorly convex curvature seen in a normal spine.
We reviewed the literature and disclosed that more than 40% of such patients that were reported with evaluable imaging studies exhibited a loss of the normal convex curvature in the lower part of the sacrum. Abnormal spinal curvature of the lower sacrum could be one of the congenital etiological factors of the development of coccygeal pad and also of anterior angulation of the coccyx, by strengthening mechanical stimulation.
We treated five keloid cases with early surgery and postoperative adjuvant therapy, because conservative therapy alone was not expected to achieve a desired therapeutic effect.
In all five cases, the postoperative course was satisfactory, and the patients were very satisfied with the outcomes.
Conservative therapy is standard first-line treatment for keloids; however, there is a risk that delay may result in an inadequate treatment effect.
After consideration of the potential adverse outcomes and limitations, early surgery and postoperative adjuvant therapy should be performed in cases in which conservative therapy alone is unlikely to achieve a desired therapeutic result.