Breast Reconstruction in a Previously Explanted Patient: An Interesting Anatomical Anomaly

Copyright 2013 The Korean Society of Plastic and Reconstructive Surgeons This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. resection is possible, no further therapy is indicated. Close observation with imaging and endocrine studies is needed. Our case is noteworthy because delayed metastasis of ACC to the facial skin is extremely rare, and there was only a solitary metastatic lesion without any tumor recurrences or distant metastases. The clinical presentations of skin metastasis are highly variable, so they may go unnoticed for a long time. Most skin metastasis appears as rapidly growing solitary or multiple round or subcutaneous nodules, and the lesion is usually painless [3]. In our case, the mass had round, non-tender, and fixed features. Because the mass seemed clinically to be a cystic tumor and no symptoms or signs had developed until 18 months after resection of the primary ACC, early detection of the skin metastasis was difficult. Additionally, there was no evidence of metastasis in the regular oncology work-up. Although the punch biopsy revealed capillary proliferation, we used imaging studies (CT and ultrasonography) with a high index of suspicion and performed a surgical excision for accurate diagnosis. In conclusion, careful examination with various diagnostic methods and total excisional biopsy are recommended for early detection of metastasis if there is any suspicious skin lesion in patients with a history of malignancy.