Immunosuppression and skin carcinogenesis: eccrine porocarcinoma - a case report and literature review

The eccrine porocarcinoma (EPC) is a rare, malignant, adnexal tumor that arises either spontaneously or from a long-standing poroma and is often misdiagnosed due to the clinical and histological similarity to basal cell or squamous cell carcinoma. EPC usually affects older individuals and can manifest as nodules, plaques, or ulcerated lesions with variable morphology, earning it the title of "the great imitator." EPC has been thought to be associated with chronic immunosuppression and UV exposure. This report presents the case of CLD in a 78-year-old male with a history of chronic lymphocytic leukemia, previously treated with fludarabine-based chemotherapy. The lesion (located in the sternal notch) was excised and confirmed histologically and immunohistochemically, showing biphasic cell populations, ductal differentiation, comedonecrosis, and a high Ki-67 index. This case highlights the diagnostic complexity of EPC and its possible relationship with immunosuppressive therapy. It emphasizes the importance of dermatologic surveillance in immunocompromised patients for early identification and management of rare secondary skin malignancies.