case_images: PMC11825106_01
case_images: Suboccipital soft tissue mass . The arrow in T1 magnetic resonance imaging (MRI) points to the 2.1 x 1.6 x 4.6 cm irregular enhancing right suboccipital soft tissue mass infiltrating the fascia and abutting the right splenius capitis and rectus capitis.
case_images: cureus-0017-00000077444-i01.jpg
case_images: PMC11825106_01_cureus-0017-00000077444-i01.jpg
case_images: FIG1
case_images: For many years, the lesion did not increase in size and was not symptomatic until six years ago, when it started to gradually grow in size and occasionally bleed, ultimately leading to surgical removal (Figures 1, 2). 
case_images: The preoperative and postoperative images of apocrine carcinoma of the scalp . A, B: the preoperative image captures the presentation of a 78-year-old male with bilateral stage IV apocrine carcinoma of the scalp, exhibiting a painless, reddish ulcer; C, D: intraoperative snapshot displays meticulous excision of the scalp mass, excision of the open wound of the posterior neck, 25 sq cm; E, F: post-treatment figures.
case_images: cureus-0017-00000077444-i02.jpg
case_images: PMC11825106_01_cureus-0017-00000077444-i02.jpg
case_images: FIG2
case_images: For many years, the lesion did not increase in size and was not symptomatic until six years ago, when it started to gradually grow in size and occasionally bleed, ultimately leading to surgical removal (Figures 1, 2).  Over time, the lesion exhibited gradual enlargement and intermittent bleeding, culminating in a 2.1 x 1.6 x 4.6 cm painless ulcerative growth with a verrucous periphery (Figure 2). Right and left neck apocrine carcinoma resections were performed, and the resulting wound (Figure 2D) was temporized with a cadaveric akin allograft (Figure 2E). Once final, negative pathologic margins were obtained, staged soft tissue reconstruction was performed by the plastic surgeons to close the wound using a left latissimus dorsi muscle free flap and split-thickness skin graft from the left thigh (Figure 2).
case_images: Histological and cytological features of the initial resection. Histology from the patient's initial resection with two proliferations with distinct histology. The first proliferation is composed of atypical epithelioid cells with ovoid to angulated nuclei forming tubular to cribriform architecture A. . A: at low power, H&E-stained histologic sections from the right neck mass resection show a lesion invading the dermis; B: perineural invasion; C: mitotic figures are present; D: by immunohistochemistry, the atypical cells are positive for androgen receptor.
case_images: cureus-0017-00000077444-i03.jpg
case_images: PMC11825106_01_cureus-0017-00000077444-i03.jpg
case_images: FIG3
case_images: Histologic and cytologic features of right neck mass. A: at low power, H&E-stained histologic sections from the right neck mass resection show a lesion invading the dermis; B: perineural invasion; C: mitotic figures are present; D: by immunohistochemistry, the atypical cells are positive for androgen receptor; E: aspirate smears show clusters of carcinoma cells with ovoid nuclei, nuclear overlapping, and variably prominent nucleoli at high power on Papanicolaou staining; and F: Romanowsky staining; G: cell block preparations with H&E staining show atypical epithelioid cells with ovoid to angulated nuclei forming clusters and tubules.
case_images: cureus-0017-00000077444-i04.jpg
case_images: PMC11825106_01_cureus-0017-00000077444-i04.jpg
case_images: FIG4
case_images: A fine-needle aspirate (FNA) biopsy of this lesion was performed for molecular analysis and displayed atypical epithelioid cells with similar morphology as the patient's prior excisions (Figure 4).  Notably, in comparison to the initial PCAC, the metastatic PCAC had prominent perineuronal invasion (Figure 4). 