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To the Editor.-We read with interest the article by Chaudhry and Zembowicz, 1 entitled "Adnexal Clear Cell Carcinoma With Comedonecrosis: Clinicopathologic Analysis of 12 Cases," in which they described a group of clinically aggressive neoplasms with common histologic features, most commonly presenting in the head/neck region. The histologic features included an infiltrative proliferation of cords and nests of epithelial cells extending throughout the skin to the deep dermis or subcutis, along with a characteristic zonation of cytologic features, including peripheral squamous cells, intermediate clear cells, and central necrosis. The tumors also demonstrated a consistent immunohistochemical staining profile, with expression of epithelial membrane antigen (EMA), cytokeratin (CK) 17, high-molecular-weight keratins, and in some cases, focal positivity of carcinoembryonic antigen. There was no definite ductal or follicular differentiation in any of the cases. In that small case series, one-third of the patients (4 of 12) suffered from tumors with aggressive behavior in the form of local recurrence (2 of 12; 17%) or local recurrence with metastatic disease (2 of 12; 17%). The authors concluded that this group of tumors merited distinction as an independent entity and proposed the name adnexal clear cell carcinoma with comedonecrosis (ACCCC).
Herein, we report an additional case of this rare tumor. We encountered a 73-year-old man with a history of solar damage and multiple nonmelanoma skin cancers who presented with a painful, hemorrhagic, erythematous nodule on the central scalp, of 6 months' duration. The patient underwent initial partial biopsy and subsequent complete excision. He has since fared well, with no evidence of recurrent or metastatic disease, although with only 9 months of follow-up. Microscopic examination of the tumor revealed an infiltrative tumor in the dermis composed of nests and islands of epithelioid cells with prominent cytologic atypia. The tumor nests exhibited the typical zonation described by Chaudhry and Zembowicz with peripheral eosinophilic squamous cells, intermediate cells with clear...