Surgical Outcomes of Cylindrocarcinoma Treated With Mohs Micrographic Surgery and Excision: A Systematic Review
May 2025 | Volume 24 | Issue 5 | 8779 | Copyright © May 2025
Published online April 7, 2025
Kaycee Nguyen BSa, Aaron Chen MBAa, Mojahed Mohammad K Shalabi MDb, Kyle C. Lauck MDc, Sino Mehrmal DOc,d, Benjamin Kelley MD MBAe, Stanislav N. Tolkachjov MDa,c,d,f,g
aTexas A&M College of Medicine, Dallas, TX
bBaylor Scott & White Medical Center, Department of Dermatology, Temple, TX
cBaylor University Medical Center, Division of Dermatology, Dallas, TX
dEpiphany Dermatology, Dallas, TX
eBighorn Mohs Surgery and Dermatology Center, Scripps Clinic, La Jolla, CA
fUniversity of Texas at Southwestern, Department of Dermatology, Dallas, TX
gVeteran Affairs Medical Center, Dallas, TX
Abstract
Background: Cylindromas are benign adnexal tumors often associated with conditions such as Brooke-Spiegler Syndrome and familial cylindromatosis. Cylindromas can undergo malignant transformation into cylindrocarcinoma. Although surgical excision is the conventional treatment method for cylindrocarcinoma, comparative studies of outcomes and recurrence rates between Mohs micrographic surgery (MMS) and surgical excision are limited.
Objective: This study's purpose is to analyze surgical outcomes of MMS and traditional surgical excision for cylindrocarcinoma based on published recurrence and metastasis data.
Methods: A systematic review was conducted utilizing PubMed and SCOPUS to identify articles addressing the treatment of cylindrocarcinoma through excision and/or MMS from inception to May 2024. The search terms included cylindrocarcinoma, malignant cylindroma, and cylindromatous carcinoma.
Results: We identified 11 articles covering 12 patients and 18 procedures. 75% of MMS treatments (3/4) exhibited no recurrence, whereas only 42% of lesions treated with surgical excision (5/12) showed no recurrence or metastasis within the follow-up periods reported in the respective studies. However, in the single MMS case that did recur, the authors noted the possibility of a separate tumor within the area, indicating a multifocal malignancy.
Limitations: This study is limited by the lack of information regarding the margin sizes of excisions, reporting bias, and the small sample size due to the rarity of these tumors.
Conclusion: MMS demonstrated a lower recurrence rate in the treatment of cylindrocarcinoma compared to surgical excision. Due to the importance of early surgical intervention and attaining clear margins, MMS should be considered a viable and effective treatment option for the treatment of cylindrocarcinoma.
J Drugs Dermatol. 2025;24(5): doi:10.36849/JDD.8779
INTRODUCTION
Cylindromas are well-circumscribed, smooth, pink nodular tumors predominantly found on the head and neck regions, frequently associated with conditions like Brooke-Spiegler Syndrome (BSS) and familial cylindromatosis. BSS patients typically present with cylindromas, spiradenomas, and trichoepitheliomas, whereas familial cylindromatosis is marked by the presence of multiple cylindromas. Over time, these cylindromas can increase in size and number, potentially covering the entire scalp and merging to form a "turban tumor." While benign cylindromas can occasionally transform into cylindrocarcinoma - a rare but aggressive tumor prone to local recurrence and metastasis - this malignant transformation is more common in multiple cylindromas than in solitary ones. Treatment for benign cylindromas generally involves wide local excision or, for inoperable cases, high-dose radiation therapy.1 However, clinical guidelines for managing cylindrocarcinoma remain undefined. Although surgical excision is the conventional treatment, comparative studies evaluating the outcomes and recurrence rates between Mohs micrographic surgery (MMS) and traditional surgical excision are limited.
MATERIALS AND METHODS
In May 2024, a systematic review was performed using the PubMed and SCOPUS databases to identify studies focusing on the treatment of cylindrocarcinoma with excision and/or Mohs micrographic surgery. The search terms included "cylindrocarcinoma", "malignant cylindroma", "cylindromatous carcinoma", "Mohs micrographic surgery", "MMS", "wide local excision", and "excision." The inclusion criteria were articles doi:10.36849/JDD.8779
