Aline Fagundes, PhD Liliane Anto ˆ nio Armando Schubach, MD, PhD and Keyla B. F. Marzochi, MD, PhD Fundação Oswaldo Cruz, Instituto de Pesquisa Clínica Evandro Chagas, Laboratório de Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brazil Aline Fagundes, PhD Laboratory of Leishmaniasis surveillance Instituto de Pesquisa Clínica Evandro Chagas Fiocruz, RJ Av. Brazil, 4365 CEP 21045-900 Rio de Janeiro Brazil E-mail: aline.fagundes@ipec.fiocruz.br Financial support: FIOCRUZ, FAPERJ, CNPq. Conflict of interest: None This study protocol was approved by the Ethics committee of Instituto de Pesquisa Clínica Evandro Chagas-IPEC/Fiocruz, receiving the number 0024.0. 009.000-04 (http://portal.saude.gov.br/sisnep/). Reference 1 Sokal JE. Editorial: Measurement of delayed skin-test responses. N Engl J Med 1975; 293: 501–502. Malignant adnexal tumors: diagnostic and therapeutic challenges in Calabar, Nigeria Adnexal carcinomas of the skin are a rare, highly malig- nant, and extremely diverse group of neoplasms. They pose a significant diagnostic and therapeutic challenge. 1 Often adnexal tumors are classified together as sweat glands. The apocrine and eccrine glands are two distinct types of glands differing in embryological origin and func- tion. Apocrine glands are derived from pilosebaceous folli- cles (includes hair follicles and sebaceous glands). The eccrine glands are considered true sweat glands. 2 Seba- ceous carcinoma is a rare, aggressive, malignant tumor derived from the adnexal epithelium of sebaceous glands. It may arise in ocular and extraocular sites. 3 Extraocular sebaceous carcinoma is a rare tumor usually found on the head and neck. 4 Eccrine porocarcinoma is a rare tumor of the skin occurring most often in the elderly and affecting more men than women. It may develop from a pre-exist- ing benign poroma. 5 They are destructive lesions with a tendency to local recurrence. 6 We present these cases of malignant adnexal tumor to highlight the rarity of this lesion as well as the diagnostic and therapeutic challenges in our setting. We evaluated the clinical histories and treatment out- comes of patients with a histologic diagnosis of malignant adnexal tumor who presented to the University of Calabar Teaching Hospital, Calabar, Nigeria, during the five year period, (January 2000–December 2004). This was com- pared with the total number of patients diagnosed with cutaneous malignancies during the same period. Table 1 shows the clinico pathological features and outcomes of management of the three patients with malignant adnexal tumor. Three patients (two female and a male) accounted for 5% of cutaneous malignancies dur- ing the period of study. The ages ranged from 36 to 58 years (mean 47 years) with a patient each in the fourth, fifth, and sixth dec- ades. Two lesions involved the scalp and one the vulva. Presentation (time when lesion was first noticed at pre- sentation in the hospital) was late, and the periods ranged from 1 to 2 years. The clinical features were that of huge fungating lesions with raised and everted edges. Two patients had regional lymphadenopathy (Table 1, Nos. 1 and 2). Diagnoses in all the cases were histologic. The diagno- sis of sebaceous carcinoma that involved the scalp (occipi- tal) in a male and the vulva was made in two patients (Table 1, Nos. 3 and 1). The third (Table 1, No. 2) had malignant eccrine porocarcinoma; the cells were basaloid, low cuboidal, and envelope areas of keratinous epidermis thereby impacting a feeling of keratinization. There were areas of cyst formation and vascular channels and cells were pleomorphic and mitosis frequent. There were two recurrences in the male patient with sebaceous carcinoma. He was lost to follow-up two months after the last sur- gery. The other two patients (one each of sebaceous and sweat gland tumor) were lost to follow-up prior to any form of treatment. Malignant adnexal tumor is a rare tumor in our region (incidence 5% of cutaneous malignancies), and other studies attest to rarity of this tumor generally. 1,3,7 There were three cases, two patients with sebaceous carcinoma and a patient with malignant eccrine tumor. Extraocular sebaceous carcinoma is a rare tumor usually found on the ª 2012 The International Society of Dermatology International Journal of Dermatology 2012, 51, 616–628 Correspondence 619