Successful pre-operative local control of skin exposure by sarcoma using combination of systemic chemotherapy and Mohs’ chemosurgery

Abstract

Background: Sarcomas sometimes invade the skin and become exposed, producing malignant wounds characterized by bleeding, exudate, odor, and infection. Malignant cutaneous sarcomas are generally incurable and ultimately impair patients' quality of life. Mohs' chemosurgery is a previously published technique for chemical fixation of a cutaneous tumor and subsequent excision. Case presentation: We present the case of a 44-year-old man with an undifferentiated pleomorphic sarcoma arising in the right chest wall and rupturing through the skin. The tumor manifested as a malignant wound with ulceration, bleeding, exudate, and a strong odor. Treatment with systemic chemotherapy and Mohs' chemosurgery was initiated. After repeated courses, the tumor demonstrated significant shrinkage. We were then able to perform wide resection and reconstruction with a rectus abdominis musculocutaneous flap. Pathologic examination of the resected specimen confirmed negative margins. Conclusions: Mohs' chemosurgery with concurrent systemic chemotherapy is an effective and reliable treatment option for achieving pre-operative local control of sarcomas that rupture through the skin.

Preoperative Mohs Paste Treatment for a Subcutaneous Sarcoma and a Skin Ulcer to Prevent Intraoperative Bleeding

“…For soft-tissue sarcomas, Mohs paste treatment is used mainly for palliative purposes in superficial ulcerated lesions with bleeding, such as angiosarcomas [ 8 ]. In contrast, Mohs paste treatment can also be used for tumor volume reduction as neoadjuvant therapy for resection in superficial soft-tissue sarcomas [ 9 , 10 , 13 ]. The current method of pre-operative Mohs paste use is a simple and definitive method; the method serves as another treatment option.…”

“…Mohs paste treatment can be used as neoadjuvant therapy with curative intent. Mohs paste treatment has a role in pre-operative volume reduction in the treatment of pleomorphic sarcomas involving the chest wall [ 9 ]. In the current report, Mohs paste treatment was used to prevent intra-operative bleeding from a subcutaneous sarcoma with a skin ulcer.…”

Effect of bacterium in the malignant wounds of soft tissue sarcoma

“…It is mainly composed of zinc chloride and was originally developed for curative treatment via repeated fixation and excision until there is complete removal of the tumor ( 6 ). Hoshi et al reported success in the combined treatment using Mohs' paste and neoadjuvant chemotherapy for undifferentiated pleomorphic sarcoma arising in the right chest wall ( 9 ). Systemic chemotherapy and Mohs' paste led to significant shrinkage of the tumor and received wide resection and reconstruction with a rectus abdominis musculocutaneous flap.…”

“…Although she had poor general condition at the first presentation to the hospital, RBC transfusion and infusion could improve the hemodynamics. In case of MWs at the first presentation, the microbiological condition is sometimes underrecognized or underestimated because physicians tend to focus on investigating the oncological condition of the patient ( 9 ). However, physicians should consider that MWs can potentially turn into a life-threatening condition when complicated by sepsis.…”

“…Previous studies mainly enrolled patients with limited life expectancy due to unresectable advanced or metastatic breast and skin cancers (4,5). Some studies reported an incidence of 3-4% for MW in patients with STS (6)(7)(8)(9).…”