Cutaneous Leiomyosarcoma: A SEER Database Analysis

Abstract

BACKGROUND Cutaneous leiomyosarcoma is a rare dermal neoplasm usually arising from the pilar smooth muscle. It is considered a relatively indolent neoplasm, and there is debate whether designation as sarcoma is appropriate. Owing to some conflicting data in the literature, however, its behavior warrants further clarification. OBJECTIVE To determine the clinical behavior and demographic and pathologic characteristics of cutaneous leiomyosarcoma. MATERIALS AND METHODS The Surveillance, Epidemiology and End Results database was used to collect data on cutaneous leiomyosarcoma and 2 reference populations: cutaneous angiosarcoma (aggressive) and atypical fibroxanthoma (indolent). Demographic and oncologic characteristics were examined, and overall survivals (OS) and disease-specific survivals were compared. RESULTS Leiomyosarcoma and atypical fibroxanthoma displayed lower stage (localized: 69.7% and 66.8% respectively), smaller size (<3 cm: 90.5% and 72%), and lower rates of disease-specific mortality (2.9% and 7.8%) compared with angiosarcoma. Patients with leiomyosarcoma had a 5-year disease-specific survival rate of 98% and OS rate of 85%. CONCLUSION Cutaneous leiomyosarcoma shows outcomes similar to atypical fibroxanthoma. It is nearly always indolent and should be distinguished from more aggressive cutaneous and subcutaneous sarcomas. Clear communication of the biologic potential may be best achieved using alternate diagnostic terminology such as “atypical intradermal smooth-muscle neoplasm.”

Prognostic factors for pleomorphic dermal sarcoma: analysis of 1911 cases from the SEER database

“…As with UPS arising at other anatomic sites, important prognostic factors PDS include distant metastasis and tumour size. Although previous studies of cutaneous sarcomas using the SEER database have been published, the conclusions drawn from them are fatally confounded by failure to account for the extent of missing data in this registry, varied therapeutic measures used (ie, surgical excision or no excision), use of poorly defined variables (eg, tumour extension), and the presence of multicollinearity in published regression models 18 19. We believe that multiple imputation, as used here, enables us to draw some tentative conclusions despite the inherent limitations of this database resource.…”

What is the nodular lesion on this patient's leg?

“…If the cancer reaches subcutaneous tissue, the risk for metastasis increases to up to 40% 4. Although cutaneous leiomyosarcomas are more likely to appear on the lower extremities, they also can be found on the face and trunk, and can present as asymptomatic or painful lesions 2,3…”

Prognosticators and Prognostic Nomograms for Leiomyosarcoma Patients With Metastasis

“…Patients with different primary tumor sites have presented various clinicopathological behaviors and overall survival (OS), indicating the fact that the survival of LMS is site-specific. Given this, the current prognostic studies of LMS mainly concentrate on identifying the prognosticators and prognostic tools in one subset (or one subgroup) of LMS patients, such as cutaneous LMS (6), extremity LMS (7,8), uterine LMS (9), urinary bladder LMS (10), and pulmonary LMS (11).…”