Treatment outcome of superficial leiomyosarcoma

Wellings, Elizabeth P.; Tibbo, Meagan E.; Rose, Peter S.; Folpe, Andrew L.; Houdek, Matthew T.

doi:10.1002/jso.26262

Cited by 4 publications

(9 citation statements)

References 27 publications

(46 reference statements)

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“…According to recent studies, disease-specific ten-year survival for superficial LMS in general was 90%, with subcutaneous LMS showing less favorable metastasis-free overall survival rates than dermal LMS (81% versus 100%, P = 0.03). 49 Recurrences were only observed in the group with subcutaneous LMS (17% versus 0%, P = 0.02). A total of 82 patients with either primary dermal LMS (n = 35, 43%) or subcutaneous LMS (defined as below the dermis but above the fascia; n = 47, 57%), were examined.…”

Section: Prognosismentioning

confidence: 93%

“…Currently available studies cannot answer the question of the optimal safety margin. According to the available evidence, we can assume that a lateral safety margin of 1 cm reduces the risk of locoregional recurrence, 3,12,16,17,49 : In the study by Wong et al, 17 recurrence of dermal and subcutaneous LMS was rare when a definitive excision with 1 cm safety margins had been performed, irrespective of additional radiation therapy. In the study by Wellings et al, 49 all recurrences occurred in subcutaneous LMS and none TA B L E 3 Safety margins for primary excision.…”

Section: Treatment Surgical Treatmentmentioning

confidence: 99%

“…According to recent studies, disease‐specific ten‐year survival for superficial LMS in general was 90%, with subcutaneous LMS showing less favorable metastasis‐free overall survival rates than dermal LMS (81% versus 100%, P = 0.03) 49 . Recurrences were only observed in the group with subcutaneous LMS (17% versus 0%, P = 0.02).…”

Section: Prognosis and Stagingmentioning

confidence: 99%

“…According to the available evidence, we can assume that a lateral safety margin of 1 cm reduces the risk of locoregional recurrence, 3,12,16,17,49 : In the study by Wong et al., 17 recurrence of dermal and subcutaneous LMS was rare when a definitive excision with 1 cm safety margins had been performed, irrespective of additional radiation therapy. In the study by Wellings et al., 49 all recurrences occurred in subcutaneous LMS and none in dermal LMS (17% versus 0%, P = 0.02); the surgical safety margin was not stated. In the study by Deneve et al., 16 no recurrences occurred after surgical removal with a mean safety margin of 1 cm after a follow‐up period of 15 months.…”

Section: Treatmentmentioning

confidence: 99%

“…Primary, microscopically controlled excision is recommended in all cases, if possible with subsequent safety margin. There is some evidence that subcutaneous forms of superficial LMS may recur more frequently and show a lower ten‐year metastasis‐free survival 17,49 . Multidisciplinary management is recommended in these cases, and the surgical approach should be discussed in an interdisciplinary tumor conference at a specialized care center (Table 3).…”

Section: Treatmentmentioning

confidence: 99%

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S1‐guideline cutaneous and subcutaneous leiomyosarcoma

Helbig

Dippel

Erdmann

et al. 2023

J Deutsche Derma Gesell

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Summary Superficial leiomyosarcomas (LMS) are rare skin cancers (2–3% of cutaneous sarcomas) that originate from dermally located hair follicle muscles, dartos or areolar muscles (cutaneous/dermal LMS), or from vascular muscle cells of the subcutaneous adipose tissue (subcutaneous LMS). These superficial LMS are distinct from LMS of the deep soft tissues. Leiomyosarcomas are typically localized at the lower extremities, trunk or capillitium, and present as painful, erythematous to brownish nodules. Diagnosis is made by histopathology. The treatment of choice for primary LMS is complete (R0) microscopically controlled excision, with safety margins of 1 cm in dermal LMS, and 2 cm in subcutaneous LMS, if possible. Non‐resectable or metastatic LMS require individual treatment decisions. After R0 resection with 1 cm safety margins, the local recurrence rate of dermal LMS is very low, and metastasis is very rare. Subcutaneous LMS, very large, or incompletely excised LMS recur and metastasize more frequently. For this reason, clinical follow‐up examinations are recommended every six months for cutaneous LMS, and every three months for subcutaneous LMS within the first two years (in subcutaneous LMS including locoregional lymph node sonography). Imaging such as CT/MRI is indicated only in primary tumors with special features, recurrences, or already metastasized tumors.

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Section: Prognosismentioning

confidence: 93%

Section: Treatment Surgical Treatmentmentioning

confidence: 99%

Section: Prognosis and Stagingmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

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S1‐guideline cutaneous and subcutaneous leiomyosarcoma

Helbig

Dippel

Erdmann

et al. 2023

J Deutsche Derma Gesell

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Management of Skin Sarcomas

Messina¹,

Cope²,

Keung³

et al. 2022

Surgical Oncology Clinics of North America

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Cutaneous leiomyosarcoma: a retrospective review of 45 cases

Khan,

Asher,

Perkins

et al. 2023

Clinical and Experimental Dermatology

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Aims Primary cutaneous leiomyosarcomas (LMS) are rare soft tissue tumours with two subtypes: dermal and subcutaneous. As deeper tumours confer a worse prognosis, they require a more aggressive approach. Conversely, a more conservative surgical approach for dermal LMS has been suggested. Few studies have comprehensively reported both clinical surgical and histological excision margins. We therefore sought to provide margin recommendations based on our experience and review of existing literature. Methods Retrospective case-note review (1998–2019) of cutaneous LMS management was undertaken to establish histological/surgical margins using pathology/electronic patient records. The diagnosis was made and classified according to the WHO classification by an experienced Dermatopathologist. Results Dermal LMS cohort (n = 35): mean peripheral and deep histological margins were 5.4 mm (range 0.5–20 mm) and 5.6 mm (range 0.1–14.5 mm), respectively. Incomplete excision rate: 31% (11/35). There were no recurrences. Subcutaneous LMS cohort (n = 10): mean peripheral and deep histological margins were 5.7 mm (range 0.2–14 mm) and 1.1 mm (range 0.2–1.7 mm), respectively. Incomplete excision rate: 40% (4/10). Recurrence rate: 20% (2/10) despite achieving histological clearance after 1 year. One lung metastasis occurred 1 year following an adequately excised primary scalp LMS. Conclusions We propose that for dermal LMS, a clinical margin of 5-10 mm (depending on size of lesion) at the initial excision or at scar re-excision following involved/close histological peripheral and/or deep margins (i.e. < 1 mm) is undertaken. For subcutaneous LMS, a clinical margin of 15-20 mm (depending on size of lesion) to achieve a peripheral histological clearance of 10 mm and negative deep margin (i.e. > 1 mm) down to periosteum/fascia/muscle according to anatomical site is suggested. If this is not achieved, a re-excision would be recommended. However, prospective studies are needed for optimal guidance.

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Treatment outcome of superficial leiomyosarcoma

Cited by 4 publications

References 27 publications

S1‐guideline cutaneous and subcutaneous leiomyosarcoma

S1‐guideline cutaneous and subcutaneous leiomyosarcoma

Management of Skin Sarcomas

Cutaneous leiomyosarcoma: a retrospective review of 45 cases

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