Aggressive multifocal recurrent porocarcinoma of the face: a case report and review of the literature.

Eccrine porocarcinoma (EPC) is a rare, aggressive skin cancer arising from eccrine sweat glands, comprising less than 0.01% of all skin cancers. Management is especially complex in immunosuppressed patients due to increased tumor aggressiveness, recurrence, and limited treatment options. We present a 69-year-old woman with recurrent facial EPC following liver and kidney transplantation for Wilson's disease and hepatitis C. Despite multiple surgeries and two courses of radiation, she experienced multifocal locoregional recurrence. Immunotherapy was contraindicated due to high graft rejection risk, and prior radiation limited options. Radical facial resection with orbital exenteration, bilateral neck dissection, and complex reconstruction using VRAM and pectoralis major flaps, scalp rotation, and skin grafting was undertaken. This case highlights the challenges of treating EPC in immunosuppressed patients and underscores the need for a multidisciplinary approach. While surgery remains the cornerstone of treatment, novel therapies including immune checkpoint inhibitors warrant further study in transplant recipients.