Leiomyosarcoma of the skin: Clinical, histopathologic, and prognostic factors that influence outcomes

Daniel S. Winchester, Thomas L. Hocker, Jerry D. Brewer, Christian Baum, Philip C. Hochwalt, Christopher J. Arpey, Clark C. Otley, Randall K. Roenigk

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)919-925
Number of pages7
JournalJournal of the American Academy of Dermatology
Volume71
Issue number5
DOIs
StatePublished - 2014

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Leiomyosarcoma
Skin
Mohs Surgery
Neoplasm Metastasis
Therapeutics
Recurrence
Neoplasms

Keywords

  • Atypical smooth muscle neoplasm
  • Cutaneous oncology
  • Dermatologic surgery
  • Leiomyosarcoma
  • Mohs micrographic surgery
  • Skin metastasis
  • Tumor differentiation
  • Wide local excision

ASJC Scopus subject areas

  • Dermatology
  • Medicine(all)

Cite this

Leiomyosarcoma of the skin : Clinical, histopathologic, and prognostic factors that influence outcomes. / Winchester, Daniel S.; Hocker, Thomas L.; Brewer, Jerry D.; Baum, Christian; Hochwalt, Philip C.; Arpey, Christopher J.; Otley, Clark C.; Roenigk, Randall K.

In: Journal of the American Academy of Dermatology, Vol. 71, No. 5, 2014, p. 919-925.

Research output: Contribution to journalArticle

Winchester, Daniel S. ; Hocker, Thomas L. ; Brewer, Jerry D. ; Baum, Christian ; Hochwalt, Philip C. ; Arpey, Christopher J. ; Otley, Clark C. ; Roenigk, Randall K. / Leiomyosarcoma of the skin : Clinical, histopathologic, and prognostic factors that influence outcomes. In: Journal of the American Academy of Dermatology. 2014 ; Vol. 71, No. 5. pp. 919-925.
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AU - Baum, Christian

AU - Hochwalt, Philip C.

AU - Arpey, Christopher J.

AU - Otley, Clark C.

AU - Roenigk, Randall K.

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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.

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