Cutaneous leiomyosarcoma: dermal and subcutaneous

Abstract

Background and objectives: Leiomyosarcoma of skin (LMS) can be sub-classified on pathology appearances as Dermal or Subcutaneous. The aim of this study was to provide treatment recommendations for these uncommon tumours. Methods: A retrospective review of all patients with dermal and subcutaneous leiomyosarcoma managed at the Peter MacCallum Cancer Centre, Australia from January 2003 to December 2018 was performed. Eighty-three patients were identified (64 dermal leiomyosarcoma, 19 subcutaneous leiomyosarcoma). Results: Subcutaneous leiomyosarcoma were larger (median size 14 mm dermal, 49 mm subcutaneous, P = 0.01). No patient with a dermal leiomyosarcoma developed metastatic disease compared to 4 of the 19 subcutaneous leiomyosarcoma (5-year overall survivals, 98% and 88%, respectively, P = 0.03). The most common site of metastasis was to the lung. No difference in risk of local recurrence was apparent (5-year recurrence-free survivals were 85% and 78%, respectively, P = 0.17). Adjuvant radiotherapy was used in 16 (25%) dermal leiomyosarcoma patients and 13 (68%) subcutaneous leiomyosarcoma patients (P < 0.001). Local recurrence was uncommon in both tumour subtypes when patients received definitive surgical excision (minimum histological margins of 10 mm as per institutional protocol) regardless of whether radiotherapy was used. The 5-year local recurrence-free survival for dermal leiomyosarcoma treated with radiotherapy was 93% versus 83% without radiotherapy (P = 0.7) and for subcutaneous leiomyosarcoma was 69% and 100%, respectively (P = 0.9). Conclusions: Dermal leiomyosarcoma have an excellent prognosis, particularly after definitive surgical excision with margins of at least 10 mm. Subcutaneous leiomyosarcoma has poorer outcomes and should be managed by wider excision and considered for adjuvant radiotherapy.

Optimal surgical treatment for paratesticular leiomyosarcoma: retrospective analysis of 217 reported cases

“…We revealed that subcutaneous LMS and high grade tumors have a poorer prognosis than their counterparts. Several retrospective studies focused on LMS of the skin revealed that subcutaneous LMS had a higher risk of DM and mortality than cutaneous LMS [ 22 – 24 ]. Moreover, several previous studies demonstrated that tumor grade was one of the strong prognostic factors for all-site LMS [ 25 ] and genitourinary STS [ 2 – 4 ].…”

Leiomiosarcoma dérmico y subcutáneo: actualización y controversias, a propósito de un caso

“…El LMSC supone en torno al 2-3% de los sarcomas cutáneos y menos del 0.05% del total de las neoplasias cutáneas 1 . El LMSC dérmico se origina del músculo erector del pelo, el dartos genital o areolar, mientras que el subcutáneo se origina de la capa muscular de los vasos del tejido celular subcutáneo y los casos metastásicos cutáneos suelen tener un origen visceral, con predominio retroperitoneal 1,2 . El LMSC dérmico se define como aquella tumoración predominantemente dérmica con o sin invasión limitada del tejido celular subcutáneo.…”

“…El LMSC dérmico se define como aquella tumoración predominantemente dérmica con o sin invasión limitada del tejido celular subcutáneo. Algunos autores subdividen este grupo en tumor atípico intradérmico de músculo liso, con prácticamente nula capacidad de extensión a distancia, y leiomiosarcoma «dérmico» con posible extensión al tejido celular subcutáneo y mínima capacidad metastásica 2,3 . Los tumores predominantemente subcutáneos, que pueden llegar a comprometer la fascia o extenderse de forma limitada a la dermis, son considerados leiomiosarcomas subcutáneos.…”

“…La edad de presentación es variable; la mayoría de los trabajos publicados coinciden en el predominio en la franja de 50 a 70 años, y afectan con más frecuencia a los varones (3:1) de raza blanca 1,2,5 . La presentación clínica es algo inespecífica y común en ambos subtipos.…”

“…La localización más frecuente es en la superficie de extensión de las extremidades (> 50-60%), sobre todo en el caso de las lesiones subcutáneas. Entre los potenciales desencadenantes se han planteado varios, como antecedentes de radioterapia local, traumatismos e incluso una intervención quirúrgica previa en la zona, sin evidencia suficiente al respecto 1,2,5,6 .…”