Cutaneous Leiomyosarcoma: Treatment and Outcomes with a Standardized Margin of Resection

Abstract

Introduction Cutaneous leiomyosarcoma (LMS) is a rare dermal-based tumor for which treatment algorithms have been poorly defined. We report our single institution experience treating cutaneous LMS using a median of a 1 cm margin for resection. Methods An IRB approved review of patients with cutaneous LMS from 2005-2010 was performed with outcomes reported. Results 33 patients with cutaneous LMS were treated, 76% were male, 97% were Caucasian with a median age of 63.5 years. 67% of tumors were located on the extremities. Pre-operative staging was negative for distant metastasis in all patients. 88% of tumors were low grade with a median tumor size of 1.3 cm. 100% of tumors tested for smooth muscle actin were positive. A majority (94%) of patients underwent primary surgical resection with a median margin of 1 cm. Final resection margin was negative in 32/33 (97%). Adjuvant radiotherapy was used in 15%. There were no recurrences or metastastic spread and 100% were alive at last follow up, median of 15.5 months. Conclusions Cutaneous LMS is primarily a low-grade malignancy affecting elderly male Caucasians. Good oncologic control and an excellent outcome are possible with a 1 cm resection margin in the vast majority of cases.

Recurrent cutaneous leiomyosarcoma of the anterior abdominal wall: a rare tumor at an unusual site

“…[13][14][15][16] The response to radiotherapy and adjuvant therapies is still not well defined in these tumors. 17 Several factors are correlated to prognosis.…”

Current approaches to cutaneous sarcomas: Dermatofibrosarcoma protuberans and cutaneous leiomyosarcoma

“…2,3 Both malignancies are slow growing tumors while LMS has a propensity to afflict Caucasian individiuals. 1 DFSP and LMS often present as firm nodules on the skin with minimal symptoms. Both cutaneous sarcomas, but especially DFSP, tend to grow in asymmetric pattern with finger-like projections and without pigmentation.…”

A Case Report On Cutaneous Leiomyosarcoma with Review of Literatures

“…Fine needle aspiration cytology of the lump is mostly inconclusive due to subtle microscopic features. Shave biopsy or punch biopsy may give better result Chest X-ray, computed tomography scan of chest and abdomen, total bone scan, whole body positron emission tomography can exclude the presence of systemic lesions or metastasis [1][2] . As metastases have rarely been described in patient with cutaneous leiomyosarcoma the utility of preoperative staging appears to add minimal clinical impact 13 .…”

“…Prognostic factors for poor results are tumour size >5cm, deep involvement with fascia, inadequate surgical excision, high grade malignancy and advanced tumour staging 2,6 . Sufficient therapy in situation of local relapse is simple re-excision suggested in literatures 1 . Deneve et al 1 in their retrospective study of 33 patients of which a total of 94% of patients underwent surgical resection with a median margin of 1cm; only 3% showed positive margins treated subsequently by re-excision and radiotherapy; no patient received adjuvant chemotherapy.…”

“…It arises from erector pili muscle of the hair follicles and sweat glands in dermis and accounts for 1% to 3% of all soft tissue sarcomas 1 . Clinical presentation varies from person to person and is not always suggestive of malignancy.…”