A Systematic Review of the Treatment of Superficial Leiomyosarcoma With Mohs Micrographic Surgery

Abstract

BACKGROUND Wide local excision (WLE) with 2 to 5 cm margins has been conventionally used for the treatment of superficial leiomyosarcoma (LMS). Because margin control is the strongest predictor of clinical recurrence, many dermatologic surgeons have recently recommended Mohs micrographic surgery (MMS) over wide local excision (WLE) as the primary treatment modality. OBJECTIVE To determine the aggregate rate of local recurrence after treatment of superficial LMS with MMS among the few reports in the literature. METHODS A systematic literature search using the PubMed/MEDLINE database and the Cochrane Library was performed from inception to June 2017. One case report from our institution was included. RESULTS A meta‐analysis of 14 reports of 48 cases of superficial LMS treated with MMS showed a mean recurrence rate of 2.08% to 6.25% with a mean follow‐up period of 1570.9 days, compared to reported recurrence rates of 30% to 50% for WLE. Among these cases there were no reports of distant metastases. CONCLUSION Treatment of superficial leiomyosarcoma with MMS shows markedly lower rates of recurrence compared to reported rates of recurrence after WLE. Further prospective trials with larger sample sizes are needed to compare both modalities.

Rapidly growing asymptomatic violaceous nodule

“…Comparatively, narrow surgical margins are associated with the highest rates of recurrence, metastasis, and disease-specific mortality. 2 , 5 Wide local excision – Correct. Because of the increased risk of local recurrence and metastasis, wide local excision is considered the gold standard of treatment.…”

“…Most of the literature recommends a 1-cm margin, whereas other sources advocate 2-cm to 5-cm margins. 2 , 3 , 5 Radiation – Incorrect. Radiation can be used adjunctively with primary surgical resection for deep LMS.…”

“…Although Mohs micrographic surgery is associated with superior results in terms of lower recurrence rates, it is not the current standard of care as the available data supporting this modality are limited to small case reports and case series. 3 , 5 For sites where wide local excision may not be appropriate, Mohs micrographic surgery is a valid alternative. 3 Doxorubicin – Incorrect.…”

“… 4 This therapy would be inappropriate for the treatment of a primary dermal LMS as surgical resection with wide margins is the treatment of choice. 3 , 5 …”

“…Comparatively, narrow surgical margins are associated with the highest rates of recurrence, metastasis, and disease-specific mortality. 2 , 5 …”