TY - JOUR
T1 - Leiomyosarcoma of the skin
T2 - Clinical, histopathologic, and prognostic factors that influence outcomes
AU - Winchester, Daniel S.
AU - Hocker, Thomas L.
AU - Brewer, Jerry D.
AU - Baum, Christian L.
AU - Hochwalt, Philip C.
AU - Arpey, Christopher J.
AU - Otley, Clark C.
AU - Roenigk, Randall K.
PY - 2014/1/1
Y1 - 2014/1/1
N2 - Background: Superficial leiomyosarcoma (LMS) is a rare tumor with important clinical, pathologic, and treatment features. Previous LMS studies have included few patients, included minimal follow-up, and typically combined the superficial and subfascial (deep) forms. Objective: We sought to characterize clinical features, effectiveness of treatment approaches, and longterm outcomes for LMS stratified by depth of invasion. Methods: In all, 71 cases of primary superficial LMS, 48 dermal and 23 subcutaneous (mean follow-up of 8 years), were examined and clinical, histopathologic, and treatment factors reported. Results: Tumor size and subcutaneous classification correlated with greater likelihood of metastasis and death at 5 years. When superficial LMS metastasizes, other skin sites are the most common distant location. Treatment with wide local excision with minimum 1-cm margins showed statistically lower rates of recurrences and metastasis compared with excision with narrow surgical margins. Fourteen cases of Mohs micrographic surgery had no recurrences or metastases. Five cases of dermal LMS metastasized, 2 of which resulted in death. Limitations: This study is a retrospective review of a relatively small number of patients. Conclusion: LMS can metastasize and warrants surgical intervention and long-term follow-up. Wide local excision, and Mohs micrographic surgery in particular, appear to provide the best management approach for definitive treatment.
AB - Background: Superficial leiomyosarcoma (LMS) is a rare tumor with important clinical, pathologic, and treatment features. Previous LMS studies have included few patients, included minimal follow-up, and typically combined the superficial and subfascial (deep) forms. Objective: We sought to characterize clinical features, effectiveness of treatment approaches, and longterm outcomes for LMS stratified by depth of invasion. Methods: In all, 71 cases of primary superficial LMS, 48 dermal and 23 subcutaneous (mean follow-up of 8 years), were examined and clinical, histopathologic, and treatment factors reported. Results: Tumor size and subcutaneous classification correlated with greater likelihood of metastasis and death at 5 years. When superficial LMS metastasizes, other skin sites are the most common distant location. Treatment with wide local excision with minimum 1-cm margins showed statistically lower rates of recurrences and metastasis compared with excision with narrow surgical margins. Fourteen cases of Mohs micrographic surgery had no recurrences or metastases. Five cases of dermal LMS metastasized, 2 of which resulted in death. Limitations: This study is a retrospective review of a relatively small number of patients. Conclusion: LMS can metastasize and warrants surgical intervention and long-term follow-up. Wide local excision, and Mohs micrographic surgery in particular, appear to provide the best management approach for definitive treatment.
KW - Atypical smooth muscle neoplasm
KW - Cutaneous oncology
KW - Dermatologic surgery
KW - Leiomyosarcoma
KW - Mohs micrographic surgery
KW - Skin metastasis
KW - Tumor differentiation
KW - Wide local excision
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U2 - 10.1016/j.jaad.2014.07.020
DO - 10.1016/j.jaad.2014.07.020
M3 - Article
C2 - 25174541
AN - SCOPUS:84922479603
SN - 0190-9622
VL - 71
SP - 919
EP - 925
JO - Journal of the American Academy of Dermatology
JF - Journal of the American Academy of Dermatology
IS - 5
ER -