Surgical Treatment of Digital Papillary Adenocarcinoma: A Systematic Review.

Abstract

Digital papillary adenocarcinoma (DPA) is a rare malignant tumor of eccrine sweat glands, primarily affecting fingers or toes. Currently, there is no established consensus on optimal treatment. Our study compares recurrence rates following various surgical treatments for DPA, including excision, digit amputation, and Mohs micrographic surgery (MMS). A systematic review conducted in June 2024 examined PubMed, Embase, Web of Science, and Scopus databases. The primary search terms included "DPA" and "aggressive digital papillary adenocarcinoma". Included studies required a histologically confirmed diagnosis of DPA, detailed surgical treatment, and follow-up recurrence or metastasis data. Studies lacking follow-up or involving concurrent treatments were excluded. A total of 43 articles encompassing 122 patients and 123 surgeries were analyzed. Our study demonstrates that MMS is associated with favorable outcomes, reporting zero recurrences in the five cases treated, compared to a 34.1% recurrence rate with surgical excision and a 20% recurrence rate with digit amputation. Understanding optimal surgical management is important for improving outcomes for patients with DPA. The primary limitations of this study include the small sample size for MMS, variability in follow-up durations, and potential reporting bias from case reports. While MMS reports on DPA treatment are limited, MMS should be considered among the surgical options for the treatment of DPA, given its excellent results, which demonstrate no recurrences or metastases in the literature. Additional comparative studies or series with more MMS would help choose between surgical options for DPA.