Giant porocarcinoma of the leg: Diagnostic and therapeutic challenges, and possible influence of the COVID-19 pandemic on the diagnosis and treatment

Abstract

Introduction: Cutaneous porocarcinoma is a rare malignant tumor, arising from the eccrine sweat gland. High rates of extracutaneous spread, local recurrence and high mortality are observed. Definitive diagnosis could be complex due to its histopathological similarity to squamous cell skin carcinoma and Paget's disease. Primary treatment still relies on surgical excision. Patient review: A 76-year-old male presented at our clinic in January 2020, with a bleeding skin tumor of the right thigh. Multiple wide surgical excisions were performed between January 2020 and November 2022, due to repetitive local recurrence. For a period of time, our patient was lost to follow up caused by COVID-19 pneumonia and a long recovery period. Initially, a poorly differentiated squamous cell skin carcinoma was reported. In the first post-COVID-19 follow-up, in January 2022, there was a new tumor locally, and porocarcinoma was diagnosed. In follow-ups, apart from skin tumor recurrence, inguinal nodal involvement was confirmed. CT showed no signs of disseminated disease in the lungs or in the abdomen, in any of the succeeding follow-ups. Finally, MRI of the pelvis revealed a suspicious mass in the bladder, radiologically consistent with metastatic disease and the patient was referred to an oncologist and a urologist. Conclusion: Porocarcinoma remains insufficiently explored. There are no official treatment protocols. Due to its similarity to squamous cell carcinoma, a dermatopathology expert should be consulted, while a multidisciplinary approach is necessary for managing the disease. Since early diagnosis and treatment are of paramount importance, any factors that delay them, such as COVID-19 pandemic in our case, could be detrimental to the patient and poorly affects the prognosis and final outcome.