What are the other Names for this Condition? (Also known as/Synonyms)

• Cutaneous Malignant Mixed Tumor
• Malignant Apocrine Mixed Tumor of Skin
• Malignant Chondroid Syringoma

What is Malignant Mixed Tumor of Skin? (Definition/Background Information)

• Malignant Mixed Tumor of Skin is a very rare malignant tumor of the sweat glands. It is a highly-aggressive tumor that is frequently known to metastasize
• There are three different types of sweat glands in the skin. These include the following:
  • Apocrine sweat glands
  • Eccrine sweat glands
  • Apoeccrine sweat glands
• Malignant Mixed Tumor of Skin is typically observed in middle-aged and older adults. The tumor is normally painless and grows slowly; the growth rate may accelerate suddenly in some cases
• The risk factors and cause of Malignant Mixed Tumor of Skin is unknown
• The treatment of choice is a surgical excision with clear margins followed by radiation therapy and/or chemotherapy, as decided by the healthcare provider
• In majority of the cases, the prognosis is good with appropriate early treatment. However, the prognosis of Malignant Mixed Tumor of Skin also depends upon the stage of the tumor, health status of the individual, and whether it has metastasized

Who gets Malignant Mixed Tumor of Skin? (Age and Sex Distribution)

• Malignant Mixed Tumor of Skin is a very uncommon tumor that can affect a wide range of individuals, from age 2-90 years. A peak incidence is seen around the age of 50 years (average age)
• Both males and females are affected, though the condition is more common in females than males in a 2:1 ratio
• There is no predilection for any racial or ethnic group

What are the Risk Factors for Malignant Mixed Tumor of Skin? (Predisposing Factors)

• Currently, the risk factors for Malignant Mixed Tumor of Skin are not well-established

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Malignant Mixed Tumor of Skin? (Etiology)

• The cause of development of Malignant Mixed Tumor of Skin is presently unknown. However, the tumor is known to arise from the sweat glands
• Genetic mutations have been suspected by researchers in some cases, but these have not been well-characterized

What are the Signs and Symptoms of Malignant Mixed Tumor of Skin?

Malignant Mixed Tumor of Skin may present the following signs and symptoms:

• It is typically seen as a solitary tumor that can vary in size from 1-18 cm
• The tumor is generally painless
• It usually grows slowly, but may have periods of sudden rapid growth
• The skin lesion may ulcerate, which can cause pain at the site
• It is a highly-aggressive, malignant tumor that is mostly present on the trunk, arms and legs (mostly on the hands and feet)

How is Malignant Mixed Tumor of Skin Diagnosed?

A diagnosis of Malignant Mixed Tumor of Skin may involve the following:

• A thorough medical history and physical examination
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Malignant Mixed Tumor of Skin?

Malignant Mixed Tumor of Skin is a very rare, but aggressive tumor that is commonly known to metastasize.

• In most cases, during the time of diagnosis metastasis would have occurred close to the tumor or near the lymph nodes (local)
• The metastasis may also involve the lungs and bones
• Ulceration of the tumor can lead to secondary infections of bacteria and fungus
• Some individuals may have concerns regarding their cosmetic appearance
• Recurrence of the tumor after a period of time, on incomplete removal
• Side effects of chemotherapy (such as toxicity) and radiation

How is Malignant Mixed Tumor of Skin Treated?

A combination of treatment methods may be used to treat Malignant Mixed Tumor of Skin. The type of surgery may include:

• Shave biopsy of skin: This procedure is used for small tumors. There is no requirement of sutures (stitches) after the surgery
• Excision of tumor: In this procedure, the tumor and surrounding tissue are removed with clear margins. Depending upon the amount of skin removed, surgical sutures may be necessary
• Mohs surgery: In this procedure, the tumor is removed layer by layer precisely, until clear margins are achieved. Each layer removed is examined under a microscope through a ‘frozen section’ procedure, for the presence of residual tumor

In most cases, a surgical removal of the entire tumor is the preferred treatment option. This can result in a cure.

• If the tumor has metastasized, then a combination of chemotherapy, radiation therapy, and invasive procedures may be used to treat the tumor
• Targeted therapy medications are generally used for locally infiltrated or metastatic tumors. This therapy destroys the tumor cells by acting against the proteins that are responsible for tumor growth
• Large tumors that have infiltrated surrounding structures can be treated with radiation therapy (the use of high-energy beams to kill cancer cells)
• Large tumors after complete skin excision may need skin grafting or a flap closure

Other techniques to treat this skin cancer (sometimes, when surgery may not be an option) may include:

• Cryotherapy: Here the tumor tissue is destroyed through a freezing technique. Typically liquid nitrogen is used to freeze the tumor
• Topical creams, such as 5-fluorouracil cream and imiquimod cream, are two examples that can be used for topical treatment. These creams may be applied for several weeks, which slowly destroys the tumor

Generally, proper follow-up care with regular screening and check-ups are important and encouraged. In the case of large lesions, close follow-up and periodic observation is essential, since they have a tendency to recur.

How can Malignant Mixed Tumor of Skin be Prevented?

• Currently, there are no known methods to prevent Malignant Mixed Tumor of Skin occurrence
• Regular medical screening at periodic intervals with blood tests, scans, and physical examinations are mandatory due to its high metastasizing potential and possibility of recurrence. Often several years of active vigilance is necessary

What is the Prognosis of Malignant Mixed Tumor of Skin? (Outcomes/Resolutions)

• Malignant Mixed Tumor of Skin is a malignant tumor and its prognosis depends upon a set of several factors, which include:
  • Stage of tumor: With lower-stage tumors, when the tumor is confined to site of origin, the prognosis is usually excellent with appropriate therapy. In higher-stage tumors, such as tumors with metastasis, the prognosis is poor
  • The surgical resectability of the tumor (meaning if the tumor can be removed completely) 
  • Overall health of the individual: Individuals with overall excellent health have better prognosis compared to those with poor health
  • Age of the individual: Older individuals generally have poorer prognosis than younger individuals
  • Whether the tumor is occurring for the first time or is a recurrent tumor. Recurrent tumors have a poorer prognosis compared to tumors that do not recur
  • Response to treatment: Tumors that respond to treatment have better prognosis compared to tumors that do not respond well to treatment
• An early diagnosis and prompt treatment of the tumor generally yields better outcomes than a late diagnosis and delayed treatment
• If metastasis (such as to the local lymph nodes) is observed, then the prognosis is unpredictable
• It has been observed that the tumor is more aggressive in some individuals, but not in others. The reason for this is not well understood
• Regular follow-up visits with the healthcare provider are important

Additional and Relevant Useful Information for Malignant Mixed Tumor of Skin:

• There is no evidence to prove that Cutaneous Malignant Mixed Tumor formation is influenced by one’s dietary choices
• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition
• The presence of dirt on the body is not a causative factor for the condition. However, it helps to be clean and hygienic, which may help the condition from getting worse