[Chemotherapy for advanced adenocarcinoma of the skin: experience with combination chemotherapy and a review of the literature].

Sweat gland carcinomas are rare malignant tumors of the skin, in addition, the diagnosis of primary sweat gland carcinoma is often difficult. Primary treatment consists of wide surgical excision with regional lymph node dissection, and the tumor is generally not radiosensitive. It has a potential for rapid growth and metastasis. Distant metastasis of sweat gland carcinomas is reputed to have a very poor prognosis because of the chemo-resistance. Most trials of chemotherapy have failed. Numerous single agents have been investigated in this disease, but in only one case did 5-fluorouracil result in complete response. Experience with combination chemotherapy in metastatic disease is limited; only several complete responses and partial responses were reported. In the literature, we found reports on several cases of sweat gland carcinoma with overt disease, which had been treated with different chemotherapeutic agents in various combinations. These studies have suggested the combined use of doxorubicin, cyclophosphamide, mitomycin C, vincristine, cisplatin, 5-fluorouracil, bleomycin and melpharan. Advanced extramammary Paget's disease is also adenocarcinoma of the skin. The recommended treatment for localized extramammary Paget's disease is wide margin resection. The role of therapy in advanced unresectable extramammary Paget's disease is unestablished. A review systemic chemotherapy of extramammary Paget's disease in the literature revealed a few complete responses and partial responses. We tried a new drug combination consisting of epirubicin, mitomycin C. vincristine, carbcplatin and 5-fluorouracil for advanced adenocarcinoma of the skin. Our two patients had excellent responses to this new regimen.