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have indicated no significant interest with commercial supporters. Case ReportA 68-year-old gentleman presented to the Veterans Administration dermatology clinic with a severalweek history of a new growth on the left ear ( Figure 1). The lesion was asymptomatic and the patient denied previous treatment to the area. He was feeling constitutionally well. Physical examination revealed a 1.0-cm pink to brown shiny opalescent crusted nodule on the left ear, spanning the midhelix and antihelix. Adenopathy was not appreciated. The initial clinical differential diagnosis included basal cell carcinoma, amelanotic malignant melanoma, and Merkel cell carcinoma. A deep shave biopsy was performed.Histologic evaluation revealed an atypical spindle cell proliferation with pleomorphic nuclei and scattered atypical mitoses infiltrating the dermis (Figures 2 and 3). Immunohistochemistry showed strong positivity for smooth muscle actin and vimentin. Desmin was focally positive. Pankeratin, S100, and Mart-1 staining were negative.A histologic diagnosis of cutaneous leiomyosarcoma was made. Excision of the primary lesion was performed. Lateral surgical margins extended 5 mm beyond the clinical boundary of the lesion, and the deep margin extended to the posterior aspect of the auricular cartilage. Clear surgical margins were confirmed histologically. A porcine xenograft Figure 1. Clinical photograph.Figure 2. Low-power magnification demonstrates an atypical spindle cell proliferation infiltrating the entire dermis. H&E; original magnification, 4 Â .

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