1
|
Gingrich A, Wangsiricharoen S, Torres MB, Ravi V, Ratan R, Keung EZ, Scally CP, Lazar AJ, Wang WL, Roland CL, Hunt KK, Yu W, Torres KE. Clinical Variables Influencing Outcomes in Patients with Atypical Intradermal Smooth Muscle Neoplasms (Formerly Cutaneous Leiomyosarcomas): Single-Institution Study of 95 Surgical Patients. Ann Surg Oncol 2024:10.1245/s10434-024-15528-x. [PMID: 39150618 DOI: 10.1245/s10434-024-15528-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/13/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Atypical intradermal smooth muscle neoplasm, also commonly termed cutaneous leiomyosarcoma, is a soft tissue tumor with a low risk of aggressive behavior. These lesions arise in the dermis with possible superficial subcutaneous extension, demonstrate cytologic atypia, and often show mitotic activity. METHODS A retrospective review of patient demographics, tumor characteristics, and treatment methods was conducted in a consecutive series of patients presenting to MD Anderson Cancer Center (MDACC) from 2002 to 2021 (n = 95). All pathology was reviewed by MDACC pathologists and determined to be atypical intradermal smooth muscle neoplasm. RESULTS Median age at diagnosis was 58 years (range 22-86), and 74% were male. Ninety-five percent (n = 90) of patients identified as White, non-Hispanic. Most tumors were slow-growing, solitary, and painless nodules. Tumors were in the lower extremities (44.2%), followed by the upper extremity (28.4%), trunk (22.1%), and head and neck (5.2%). All patients (n = 44, 46.3%) who had a punch/incisional biopsy for diagnostic purposes had a subsequent tumor excision. Unplanned excision or excisional biopsy was performed on the remaining 46 (48%) patients. Of this subset, 41 of the 46 aforementioned patients (89%) had positive margins and underwent re-excision. Final pathology in 25/38 (66%) re-excision specimens was negative for residual tumor despite an initial positive margin. Two patients in the cohort had local recurrence 2 and 3 years after initial surgery. Both patients had positive margins, underwent excision of the recurrent tumor, and remain free of disease. After median follow-up of 6.9 years (range 1 day-18 years), 5-year recurrence-free survival was 96% and overall survival (OS) of the entire cohort was 78%. CONCLUSION In this study of consecutive patients presenting with atypical intradermal smooth muscle neoplasm, we found good OS and local control after definitive surgical excision with negative margins, including excisional biopsy with close margins. Atypical intradermal smooth muscle neoplasm is unlikely to metastasize and has an excellent prognosis. Guidelines to determine optimal surveillance strategies for these patients should be revisited.
Collapse
Affiliation(s)
- Alicia Gingrich
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Madeline B Torres
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vinod Ravi
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ravin Ratan
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Emily Z Keung
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christopher P Scally
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alexander J Lazar
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wei-Lien Wang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christina L Roland
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kelly K Hunt
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wendong Yu
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Keila E Torres
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| |
Collapse
|
2
|
Drexler K, Bollmann L, Karrer S, Berneburg M, Haferkamp S, Niebel D. Retrospective Single-Center Case Study of Clinical Variables and the Degree of Actinic Elastosis Associated with Rare Skin Cancers. BIOLOGY 2024; 13:529. [PMID: 39056721 PMCID: PMC11274094 DOI: 10.3390/biology13070529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024]
Abstract
(1) Background: Rare skin cancers include epithelial, neuroendocrine, and hematopoietic neoplasias as well as cutaneous sarcomas. Ultraviolet (UV) radiation and sunburns are important drivers for the incidence of certain cutaneous sarcomas; however, the pathogenetic role of UV light is less clear in rare skin cancers compared to keratinocyte cancer and melanoma. In this study, we compared the degree of actinic elastosis (AE) as a surrogate for lifetime UV exposure among selected rare skin cancers (atypical fibroxanthoma [AFX], pleomorphic dermal sarcoma [PDS], dermatofibrosarcoma protuberans [DFSP], Kaposi sarcoma [KS], Merkel cell carcinoma [MCC], and leiomyosarcoma [LMS]) while taking into account relevant clinical variables (age, sex, and body site). (2) Methods: We newly established a semi-quantitative score for the degree of AE ranging from 0 = none to 3 = total loss of elastic fibers (basophilic degeneration) and multiplied it by the perilesional vertical extent (depth), measured histometrically (tumor-associated elastosis grade (TEG)). We matched the TEG of n = 210 rare skin cancers from 210 patients with their clinical variables. (3) Results: TEG values were correlated with age and whether tumors arose on UV-exposed body sites. TEG values were significantly higher in AFX and PDS cases compared to all other analyzed rare skin cancer types. As expected, TEG values were low in DFSP and KS, while MCC cases exhibited intermediate TEG values. (4) Conclusions: High cumulative UV exposure is more strongly associated with AFX/PDS and MCC than with other rare skin cancers. These important results expand the available data associated with rare skin cancers while also offering insight into the value of differentiating among these tumor types based on their relationship with sun exposure, potentially informing preventative, diagnostic and/or therapeutic approaches.
Collapse
Affiliation(s)
| | | | | | | | | | - Dennis Niebel
- Department of Dermatology, University Medical Center Regensburg, 93053 Regensburg, Germany; (K.D.)
| |
Collapse
|
3
|
Gkantaifi A, Diamantis A, Mauri D, Nixon I, Kyriazoglou A, Baloyiannis I, Tsoukalas N, Charalampakis N, Schizas D, Cuccia F, Alongi F, de Mello RA, Iliadis G, Kamposioras K, Mazonakis M, Tolia M. Cutaneous soft tissue sarcomas: survival-related factors. Arch Dermatol Res 2021; 314:625-631. [PMID: 34272971 DOI: 10.1007/s00403-021-02268-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 06/12/2021] [Accepted: 06/30/2021] [Indexed: 11/25/2022]
Abstract
Cutaneous sarcomas are a heterogeneous group of rare mesenchymal neoplasms representing less than 1% of malignant tumors. Histology report remains the cornerstone for the diagnosis of these tumors. The most important clinicopathologic parameters related to prognosis include larger tumor size, high mitotic index, head and neck location, p53 mutations, depth of infiltration and histological grade, vascular and perineural invasion as well as the surgical margins status. Applying advanced biopsy techniques might offer more precise assessment of surgical margins, which constitutes a significant precondition for the management of these tumors. The management of cutaneous soft tissue sarcomas requires a multidisciplinary approach. Surgery remains the standard treatment, nonetheless adjuvant therapy may be required, consisting of radiotherapy, chemotherapy, and molecular targeted therapies to improve treatment outcomes. The role of molecular profiling in the treatment of uncontrolled disease is promising, but it may be offered to a relatively small proportion of patients and its use is still considered experimental in this setting. Due to the rarity of the disease, there is a need for knowledge and experience to be shared, pooled, organized and rationalized so that recent developments in medical science can have a major impact on the disease course. Multicenter clinical trials are needed to improve the care of patients with cutaneous sarcomas.
Collapse
Affiliation(s)
- Areti Gkantaifi
- Radiotherapy Department, Theagenio Anticancer Hospital of Thessaloniki, Thessaloniki, Greece
| | - Alexandros Diamantis
- Department of General Surgery, University Hospital of Larisa, Biopolis, 415 00, Larisa, Thessaly, Greece
| | - Davide Mauri
- Department of Medical Oncology, University Hospital of Ioannina, Ioannina, Greece
| | - Ioanna Nixon
- Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - Anastassios Kyriazoglou
- 2nd Propaedeutic Department of Medicine, Attikon University Hospital, Rimini St, Chaidari, 124 62, Athens, Greece
| | - Ioannis Baloyiannis
- Department of General Surgery, University Hospital of Larisa, Biopolis, 415 00, Larisa, Thessaly, Greece
| | | | | | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Francesco Cuccia
- Advanced Radiation Oncology Department, IRCCS SacroCuore Don Calabria, Negrar, Verona, Italy
- University of Brescia, Brescia, Italy
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS SacroCuore Don Calabria, Negrar, Verona, Italy
- University of Brescia, Brescia, Italy
| | - Ramon Andrade de Mello
- Precision Oncology and Health Economics Research Group, Division of Medical Oncology, Federal University of São Paulo (UNIFESP) and Post Graduation Program in Medicine, Nine of July University (UNINOVE), São Paulo, Brazil
- Algarve Biomedical Center, Division of Oncology, Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal
| | - George Iliadis
- Radiotherapy Department, Interbalkan Medical Center, Thessaloniki, Greece
| | | | - Michalis Mazonakis
- Department of Medical Physics, Faculty of Medicine, University of Crete, P.O. Box 2208, 710 03, Iraklion, Crete, Greece
| | - Maria Tolia
- Department of Radiotherapy, University Hospital/Medical School, University of Crete, Vassilika, 711 10, Crete, Greece.
| |
Collapse
|
4
|
Rosenfeld DJ, Cappel MA, Tolkachjov SN. Cutaneous mesenchymal tumors treated with Mohs micrographic surgery: a comprehensive review. Int J Dermatol 2021; 60:1334-1342. [PMID: 33715156 DOI: 10.1111/ijd.15500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 11/23/2020] [Accepted: 02/08/2021] [Indexed: 12/20/2022]
Abstract
Cutaneous mesenchymal tumors (CMT) are rare tumors with wide clinicopathologic heterogeneity. Treatment of malignant cutaneous mesenchymal tumors traditionally includes wide local excision (WLE), though Mohs micrographic surgery (MMS) has been increasingly used. A PubMed literature review of articles from inception until September 2019 related to malignant CMT and surgical treatment with MMS or WLE was completed. Dermatofibrosarcoma protuberans treated with MMS recurred in 1.2% of patients with no reported metastasis. Atypical fibroxanthoma treated with MMS recurred and metastasized in 2.7 and 2.5%, respectively. Undifferentiated pleomorphic sarcoma treated with MMS recurred in 32% with an unknown metastatic rate. Superficial leiomyosarcoma treated with MMS recurred in 3.8% with no reported metastasis. Cutaneous angiosarcoma and myofibrosarcoma treated with MMS have shown no recurrence or metastatic disease, but literature is sparse. The rarity of malignant CMT and the lack of comparative data on treatment make conclusive treatment recommendations difficult. However, recent literature suggests MMS is a useful option and potentially a superior treatment for primary cutaneous mesenchymal tumors.
Collapse
Affiliation(s)
- David J Rosenfeld
- Department of Dermatology, Loyola University Medical Center, Maywood, IL, USA
| | - Mark A Cappel
- Dermatopathology, Gulf Coast Dermatopathology Laboratory Dermatology, Dermatology Associates of Tampa Bay, Tampa, FL, USA
| | - Stanislav N Tolkachjov
- Dermatology and Mohs Micrographic and Reconstructive Surgery, Epiphany Dermatology, Dallas, TX, USA
| |
Collapse
|
5
|
ACAR A, YAMAN B, YANMAZ A, YOLDAŞ AH, KARAARSLAN I, AKALIN T, ÖZDEMİR F, GERÇEKER TÜRK B, CANER A, KANDİLOĞLU G, HAYDAROĞLU A, CEYLAN C. Ege Üniversitesi Hastanesinde görülen melanom dışı deri kanserlerinin epidemiyolojik ve demografik özellikleri. EGE TIP DERGISI 2020. [DOI: 10.19161/etd.815373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
6
|
Kazlouskaya V, Lai YC, Khachemoune A. Leiomyosarcoma of the skin: review of the literature with an emphasis on prognosis and management. Int J Dermatol 2019; 59:165-172. [PMID: 31729020 DOI: 10.1111/ijd.14705] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/15/2019] [Accepted: 10/19/2019] [Indexed: 12/30/2022]
Abstract
Leiomyosarcoma (LMS) of the skin is rare, and no management guideline currently exists. Although LMS is historically classified as either dermal (cutaneous) or subcutaneous, definition for its classfication is inconsistent in the literature. Studies on the managenent of LMS are scarce, and there is no consensus on the appropriate surgical margin for the treatment of LMS. While a 1 cm margin may be sufficient in cutaneous LMS, wider margins may be required for subcutaneous tumors. Mohs micrographic surgery is a promising surgical modality for the treatment of cutaneous LMS. In this review, current knowledge on LMS is summarized and a practical approach to the management of this rare neoplasm is proposed.
Collapse
Affiliation(s)
| | - Yi C Lai
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Amor Khachemoune
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, NY, USA.,Department of Dermatology, Brooklyn Veterans Hospital, Brooklyn, NY, USA
| |
Collapse
|
7
|
Wollina U, Nowak A, Tchernev G, Lotti T. Chronic Scalp Ulcer 35 Years after Skull Trepanation Surgery and Radiotherapy for Oligodendroglioma: A Further Example of Immunocompromised Cutaneous Districts. Open Access Maced J Med Sci 2018; 6:55-57. [PMID: 29483982 PMCID: PMC5816315 DOI: 10.3889/oamjms.2018.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/17/2017] [Accepted: 08/19/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND: Chronic ulcers of the scalp have a variety of underlying pathologies. In case of cancer patients, a second malignancy must be excluded. CASE REPORT: A 78-year-old female patient presented to our department with a large soft tissue defect on the frontotemporal left side. The lesion was about 3 cm in diameter with exposed bone and inflammatory soft tissue on the edges of the defect. About 35 years ago, she had undergone a combined neurosurgery with skull trepanation and radiotherapy for an oligodendroglioma. Three years ago, sandwich transplantation with the dermal template and meshed skin graft failed. Now she re-presented with inflammatory ulcer borders. A complex defect repair was performed after exclusion of a second malignancy. CONCLUSION: Chronic scalp ulcers may be the result immunocompromised cutaneous districts and need a complex reconstruction.
Collapse
Affiliation(s)
- Uwe Wollina
- Städtisches Klinikum Dresden, Dresden, Sachsen, Germany; Academic Teaching Hospital Dresden-Friedrichstadt, Germany
| | - Andreas Nowak
- Department of Anesthesiology & Intensive Care Medicine, Emergency Medicine & Pain Management, Dresden, Germany
| | - Georgi Tchernev
- Medical Institute of Ministry of Interior (MVR), Department of Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria.,Onkoderma - Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
| | - Torello Lotti
- Università Degli Studi "G. Marconi", Rome, Italy, Facoltà di Medicina e Chirurgia - Chair of Dermatology, University of Rome, Rome, Italy
| |
Collapse
|