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Moody R, Darji K, Missall TA, Chow P, Behshad R. A Case of Pleomorphic Dermal Sarcoma: Giant Exophytic Tumor of the Medial Canthus. Dermatopathology (Basel) 2023; 11:13-18. [PMID: 38247725 PMCID: PMC10801471 DOI: 10.3390/dermatopathology11010003] [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: 09/06/2023] [Revised: 12/12/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
We present the case of a 99-year-old Caucasian female who was referred for treatment of a painless, 8.0 cm × 7.8 cm exophytic, pedunculated, ulcerated tumor of the left medial canthus. Pathology showed spindled, oval, and polygonal cells with pleomorphic nuclei. Many multinuclear giant cells and mitotic figures were also noted. The tumor was highlighted with CD10, showed focal positivity with actin, desmin, and CD68, and had increased Ki67 immunohistochemical staining. The tumor was negative for pancytokeratin, CK5/6, p63, MART-1/MelanA, S100, Sox10, p40, CD34, and CD23. Based on clinicopathologic correlation, the diagnosis of pleomorphic dermal sarcoma (PDS) was made. Pleomorphic dermal sarcoma (PDS) refers to a deep, histologically high-grade tumor that often resembles other tumors clinically and histologically. As PDS is frequently aggressive and related to adverse outcomes, it is important to recognize its distinguishing features in comparison to other similar entities, including atypical fibroxanthoma (AFX) and pleomorphic leiomyosarcoma (PLMS). To our knowledge, there is only one other reported case in the literature of PDS occurring on the eye. By reviewing and understanding characteristic etiologies, locations of presentation, histopathological features, and management techniques, pathologists can make a more accurate diagnosis and dermatologists can provide more effective patient care in a timely manner.
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Affiliation(s)
- Rylee Moody
- School of Medicine, Saint Louis University, 1008 S Spring Ave, St. Louis, MO 63110, USA
| | - Kavita Darji
- Department of Dermatology, SSMHealth SLUCare, Saint Louis University, 1008 S Spring Ave, St. Louis, MO 63110, USA
| | - Tricia A. Missall
- Department of Dermatology, University of Florida, Gainesville, FL 32606, USA
| | - Peter Chow
- Department of Dermatology, SSMHealth SLUCare, Saint Louis University, 1008 S Spring Ave, St. Louis, MO 63110, USA
| | - Ramona Behshad
- Department of Dermatology, SSMHealth SLUCare, Saint Louis University, 1008 S Spring Ave, St. Louis, MO 63110, USA
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2
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Meyer SN, Ren Y, Taylor S, Kiuru M, Eisen DB. Mohs micrographic surgery versus wide local excision for the treatment of atypical fibroxanthoma: A retrospective cohort analysis. JAAD Int 2023; 12:174-176. [PMID: 37520753 PMCID: PMC10371835 DOI: 10.1016/j.jdin.2023.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Affiliation(s)
- Summer N. Meyer
- Department of Dermatology, University of California, Davis School of Medicine, Sacramento, California
| | - Yunyi Ren
- Department of Public Health Sciences, University of California, Davis School of Medicine, Sacramento, California
| | - Sandra Taylor
- Department of Public Health Sciences, University of California, Davis School of Medicine, Sacramento, California
| | - Maija Kiuru
- Department of Dermatology, University of California, Davis School of Medicine, Sacramento, California
- Department of Pathology and Laboratory Medicine, University of California, Davis School of Medicine, Sacramento, California
| | - Daniel B. Eisen
- Department of Dermatology, University of California, Davis School of Medicine, Sacramento, California
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3
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Coelho-Lima J, Bruty J, Watkins J, Liu H, Price R, Stefanos N. Clear cell variant of atypical fibroxanthoma and pleomorphic dermal sarcoma: molecular characterization and review of the literature. J Cutan Pathol 2022; 49:1031-1034. [PMID: 35922373 DOI: 10.1111/cup.14307] [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: 03/18/2022] [Revised: 07/27/2022] [Accepted: 08/01/2022] [Indexed: 11/30/2022]
Abstract
Atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS) are unusual cutaneous tumors that typically arise in sun-damaged skin of elderly individuals. Several histopathologic variants have been described, but the clear cell variant is particularly rare with only 18 cases of AFX and 1 case of PDS reported. Here, we present two cases of clear cell AFX and PDS highlighting key histopathologic findings and molecular alterations assessed by next generation sequencing (NGS).
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Affiliation(s)
- Jose Coelho-Lima
- Histopathology Registrar, Addenbrooke's Hospital, Cambridge, UK.,NIHR Academic Clinical Fellow, University of Cambridge, Cambridge, UK
| | - Jonathan Bruty
- Clinical Scientist, East of England Genomic Laboratory Hub, Cambridge, UK
| | - James Watkins
- Consultant Histopathologist, Addenbrooke's Hospital, Cambridge, UK
| | - Hongxiang Liu
- Consultant Clinical Scientist, East of England Genomic Laboratory Hub, Cambridge, UK
| | - Richard Price
- Consultant Plastic Surgeon, Addenbrooke's Hospital, Cambridge, UK
| | - Niki Stefanos
- Consultant Histopathologist, Addenbrooke's Hospital, Cambridge, UK
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Messina V, Cope B, Keung EZ, Fiore M. Management of Skin Sarcomas. Surg Oncol Clin N Am 2022; 31:511-525. [DOI: 10.1016/j.soc.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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5
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Ørholt M, Aaberg FL, Abebe K, Walsh S, Roenigk RK, Venzo A, Schmidt G, Klyver H, Jensen DH, Herly M, Vester-Glowinski PV. Risk factors for local atypical fibroxanthoma recurrence and progression to pleomorphic dermal sarcoma: A meta-analysis of individualized participant data. J Surg Oncol 2022; 126:555-562. [PMID: 35441377 PMCID: PMC9544245 DOI: 10.1002/jso.26898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/14/2022] [Accepted: 04/07/2022] [Indexed: 11/09/2022]
Abstract
Background Risk factors for local atypical fibroxanthoma (AFX) recurrence and progression to pleomorphic dermal sarcoma (PDS) have not previously been identified. Objective To identify risk factors and provide follow‐up suggestions for local AFX recurrence and progression to PDS. Methods and Materials A literature search was performed in the PubMed, EMBASE, and Cochrane databases. The PRISMA and MOOSE guidelines were followed. The risks of local AFX recurrence and progression to PDS were presented as Kaplan–Meier plots and risk factors were presented as hazard ratios (HRs) calculated with univariate and multivariate Cox regression. Results Five hundred and ninety‐eight patients with AFX from 14 studies were included. Age >74 years and male sex significantly increased the risk of local recurrence (HR: 7.31 [95% confidence interval [CI]: 1.78–30.0], p < 0.01 and HR: 2.89 [95% CI: 1.04–8.01], p < 0.05, respectively). There was no difference when comparing wide local excision and Mohs' micrographic surgery (p = 0.89). The risks of local AFX recurrence and progression to PDS after 2 years were <1%. Conclusion A more intensive follow‐up regimen could be considered in patients >74 years old and males due to the higher risk of local AFX recurrence.
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Affiliation(s)
- Mathias Ørholt
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Frederik L Aaberg
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kiya Abebe
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - S Walsh
- Department of Oral and Maxillofacial Surgery, University Hospitals Sussex: St Richard's Hospital, Chichester, West Sussex, UK
| | - Randall K Roenigk
- Department of Dermatology and Division of Dermatologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alessandro Venzo
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Grethe Schmidt
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Helle Klyver
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - David H Jensen
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Herly
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Peter V Vester-Glowinski
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Sim JY, Lee DH, Jang B, Suh MJ. Atypical Fibroxanthoma Resected without Auricular Deformity in an Elderly Patient: A Case Study. EAR, NOSE & THROAT JOURNAL 2022:1455613221084072. [PMID: 35387526 DOI: 10.1177/01455613221084072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Atypical fibroxanthoma (AFX) is a dermal spindle-cell cutaneous malignancy, which is a relatively benign type of skin cancer that occurs in the elderly with sun-damaged skin. This is a case study of a rapidly enlarged left auricular mass lesion in an elderly patient who was diagnosed with AFX based on histopathological and immunohistochemical findings, and then treated by complete excision to prevent recurrence or metastasis. There was no recurrence during the 1-year follow-up. For otolaryngologists or plastic surgeons, recognizing the clinical and pathologic characteristics of AFX is important for accurate diagnosis and treatment.
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Affiliation(s)
- Jae-Yeop Sim
- Department of Otorhinolaryngology, 91577Jeju National University College of Medicine, Jeju-do, Korea
| | - Dong Hui Lee
- Department of Pathology, 37984Jeju National University College of Medicine, Jeju-do, Korea
| | - Bogun Jang
- Department of Pathology, 37984Jeju National University College of Medicine, Jeju-do, Korea
| | - Michelle J Suh
- Department of Otorhinolaryngology, 91577Jeju National University College of Medicine, Jeju-do, Korea
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Jibbe A, Worley B, Miller CH, Alam M. Surgical excision margins for fibrohistiocytic tumors, including atypical fibroxanthoma and undifferentiated pleomorphic sarcoma: A probability model based on a systematic review. J Am Acad Dermatol 2021; 87:833-840. [PMID: 34587553 DOI: 10.1016/j.jaad.2021.09.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 08/30/2021] [Accepted: 09/04/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Mohs micrographic surgery or wide local excision is the treatment of choice for fibrohistiocytic tumors with metastatic potential, including atypical fibroxanthoma (AFX) and cutaneous undifferentiated pleomorphic sarcoma (cUPS). Since margin clearance is the strongest predictor of clinical recurrence, improved recommendations for appropriate surgical margins help delineate uniform excision margins when intraoperative margin assessment is not available. OBJECTIVE To determine appropriate surgical wide local excision margins for AFX and cUPS. METHODS Literature search (Ovid MEDLINE, Embase, Web of Science, and Cochrane Library from inception to March 2020) to detect case-level data. Estimation of margins required using a mathematical model based on extracted cases without recurrences. RESULTS Probabilistic modeling based on 100 cases extracted from 37 studies showed peripheral clearance margin (ie, wide local excision margin) calculated to clear 95% of all tumors was 2 cm for AFX and 3 cm for cUPS. AFX tumors 1 cm or less required a margin of 1 cm. LIMITATIONS Data were extracted from published cases. CONCLUSIONS Atypical fibroxanthoma removed with at least a 2-cm peripheral excision margin is less likely to recur. Smaller tumors 1 cm or less can be treated with a more conservative margin. Margin-control surgical techniques are recommended to ensure complete removal while minimizing surgical morbidity.
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Affiliation(s)
- Atieh Jibbe
- Division of Dermatology, Department of Internal Medicine, University of Kansas, Kansas City, Kansas
| | - Brandon Worley
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Florida Dermatology and Skin Cancer Centers, Lake Wales, Florida
| | - Corinne H Miller
- Galter Health Sciences Library & Learning Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Otoloaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
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8
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Ripa V, Singh N, Star AE, Smith F. Progression of the atypical fibroxanthoma to pleomorphic dermal sarcoma in a heart transplant patient. BMJ Case Rep 2021; 14:14/7/e242359. [PMID: 34215640 DOI: 10.1136/bcr-2021-242359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An 82-year-old man presented with a right scalp lesion which had been increasing in size. The patient's medical history was significant for a heart transplant 25 years before, and he was on chronic immunosuppression. Biopsy of the lesion showed atypical fibroxanthoma. The patient underwent an excision of the lesion with split thickness skin graft. Pathology showed fibroxanthoma with negative margins. Over the next 9 months, the patient developed new lesions, which were also excised to negative margins. However, with each new lesion, the histology demonstrated increasing dysplasia and ultimately pleomorphic sarcoma. The patient had a metastatic workup with CT of the chest, which was negative, and he underwent a radical scalpectomy, split thickness skin graft placement and adjuvant radiation therapy. The patient has not developed any new scalp lesions and no evidence of metastasis.
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Affiliation(s)
- Valeria Ripa
- General Surgery, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Natasha Singh
- Pathology, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Allen E Star
- General Surgery, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Franz Smith
- Surgery, Saint Barnabas Medical Center, Livingston, New Jersey, USA
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Ak M, Kahraman A, Arnold FM, Turko P, Levesque MP, Zoche M, Ramelyte E, Dummer R. Clinicopathological and Genomic Profiles of Atypical Fibroxanthoma and Pleomorphic Dermal Sarcoma Identify Overlapping Signatures with a High Mutational Burden. Genes (Basel) 2021; 12:genes12070974. [PMID: 34202213 PMCID: PMC8303615 DOI: 10.3390/genes12070974] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 12/27/2022] Open
Abstract
Atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS) are rare tumors developing in chronically sun-exposed skin. Clinicopathological features are similar, but they differ in prognosis, while PDS has a more aggressive course with a higher risk for local recurrence and metastases. In current clinical practice, they are diagnosed by exclusion using immunohistochemistry. Thus, stringent diagnostic criteria and correct differentiation are critical in management and treatment for optimal outcomes. This retrospective single-center study collected clinicopathological data and tumor samples of 10 AFX and 18 PDS. Extracted genomic DNA from tumor specimens was analyzed by a next-generation sequencing (NGS) platform (FoundationOne-CDx™). Among 65 identified mutations, TP53 inactivating mutations were observed in all tumor specimens. In both AFX and PDS, the known pathogenic gene alterations in CDKN2A, TERT promoter, and NOTCH1 were frequently present, along with high mutational burden and stable Micro-Satellite Instability status. The mutational profiles differed only in ASXL1, which was only present in AFX. Further differences were identified in likely pathogenic and unknown gene alterations. Similarities in their genomic signatures could help to distinguish them from other malignancies, but they are not distinguishable between each other using the FoundationOne-CDx™ NGS panel. Therefore, histological criteria to determine diagnosis remain valid. For further insight, performing deep tumor profiling may be necessary.
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Affiliation(s)
- Melike Ak
- Dermatology Department, University Hospital Zurich, 8091 Zurich, Switzerland; (M.A.); (P.T.); (M.P.L.); (E.R.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland; (A.K.); (F.M.A.); (M.Z.)
| | - Abdullah Kahraman
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland; (A.K.); (F.M.A.); (M.Z.)
- Pathology Department, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Fabian M. Arnold
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland; (A.K.); (F.M.A.); (M.Z.)
- Pathology Department, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Patrick Turko
- Dermatology Department, University Hospital Zurich, 8091 Zurich, Switzerland; (M.A.); (P.T.); (M.P.L.); (E.R.)
| | - Mitchell P. Levesque
- Dermatology Department, University Hospital Zurich, 8091 Zurich, Switzerland; (M.A.); (P.T.); (M.P.L.); (E.R.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland; (A.K.); (F.M.A.); (M.Z.)
| | - Martin Zoche
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland; (A.K.); (F.M.A.); (M.Z.)
- Pathology Department, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Egle Ramelyte
- Dermatology Department, University Hospital Zurich, 8091 Zurich, Switzerland; (M.A.); (P.T.); (M.P.L.); (E.R.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland; (A.K.); (F.M.A.); (M.Z.)
| | - Reinhard Dummer
- Dermatology Department, University Hospital Zurich, 8091 Zurich, Switzerland; (M.A.); (P.T.); (M.P.L.); (E.R.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland; (A.K.); (F.M.A.); (M.Z.)
- Correspondence: ; Tel.: +41-44-255-11-11
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Jang N, Shin HW, Yoon KC. Locally Advanced Pleomorphic Dermal Sarcoma of the Forearm. J Hand Surg Am 2021; 46:521.e1-521.e5. [PMID: 33082036 DOI: 10.1016/j.jhsa.2020.07.020] [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: 03/22/2020] [Accepted: 07/30/2020] [Indexed: 02/02/2023]
Abstract
Pleomorphic dermal sarcoma (PDS) is a rare mesenchymal tissue tumor that shares pathological features with atypical fibroxanthoma, but also exhibits tumor necrosis, invasion beyond the superficial subcutis, and vascular or perineural infiltration. In addition, PDS also has relatively high rates of local recurrence and metastasis and is usually encountered in elderly men, especially in the head and neck area. In this article, we report a rare case of PDS that infiltrated the fascial tissues in the forearm of a female patient. After wide local excision, the defect was covered with an anterolateral thigh free flap and adjuvant radiotherapy was instituted.
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Affiliation(s)
- Nam Jang
- Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Woo Shin
- Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Kun Chul Yoon
- Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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11
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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.
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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
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13
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Bowe CM, Godhania B, Whittaker M, Walsh S. Pleomorphic dermal sarcoma: a clinical and histological review of 49 cases. Br J Oral Maxillofac Surg 2020; 59:460-465. [PMID: 33441282 DOI: 10.1016/j.bjoms.2020.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 09/04/2020] [Indexed: 11/24/2022]
Abstract
Pleomorphic dermal sarcoma (PDS) is a rare mesenchymal neoplasm that shares histopathological features with atypical fibroxanthoma (AFX), but has additional features of deep invasion of the superficial subcutis, tumour necrosis, and vascular and perineural invasion, which confers a risk of local recurrence and metastases. To study the clinical and pathological spectrum more comprehensively, we retrieved 49 cases of pleomorphic dermal sarcoma from our departmental files. There was a strong male predominance (n=45). The mean (range) age at presentation was 80 (47-97) years. The tumours had a median (range) maximum dimension of 23.5 (5-75) mm. There was a strong predilection for the head and face (n=47), with the scalp (n=32) being the most common site. Ulceration was observed in 21 patients, tumour necrosis in seven, perineural infiltration in six, and lymphovascular invasion in two. CD10 was expressed in all cases. Smooth muscle actin was expressed in 15 and CD68 in 14. Follow up was available in 41 cases (mean (range) 22.4 (2-90) months). Six patients had local recurrences, despite all having originally undergone primary surgical resections and having reports of clear margins. Progressive metastatic disease was observed in one patient who died from their disease. Based on the Kaplan Meier method, median overall survival was 70.8 (8.4-133.1) months. Although AFX and PDS may be part of a spectrum, distinction is important to emphasise the potential for malignant behaviour in PDS.
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Affiliation(s)
- C M Bowe
- Oral & Maxillofacial Surgery Department, St. Richards Hospital, Chichester.
| | - B Godhania
- Oral & Maxillofacial Surgery Department, St. Richards Hospital, Chichester
| | - M Whittaker
- Department of Pathology, St. Richards Hospital, Chichester
| | - S Walsh
- Oral & Maxillofacial Surgery Department, St. Richards Hospital, Chichester
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14
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Recurrent pleomorphic dermal sarcoma of the temporal bone: Case report and literature review. OTOLARYNGOLOGY CASE REPORTS 2020. [DOI: 10.1016/j.xocr.2020.100181] [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
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16
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Iglesias‐Pena N, López‐Solache L, Martínez‐Campayo N, Meilán‐Sánchez I, Yebra‐Pimentel MT, Balboa‐Barreiro V, Paradela S, Fonseca E. Incidence rate and clinicopathological features of 62 atypical fibroxanthomas in a North‐Western Spanish population. Australas J Dermatol 2019; 61:e22-e27. [DOI: 10.1111/ajd.13102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/23/2019] [Indexed: 12/12/2022]
Affiliation(s)
| | - Laura López‐Solache
- Pathology Department Complejo Hospitalario Universitario A CoruñaA Coruña Spain
| | | | - Iago Meilán‐Sánchez
- Dermatology DepartmentComplejo Hospitalario Universitario A Coruña A Coruña Spain
| | | | | | - Sabela Paradela
- Dermatology DepartmentComplejo Hospitalario Universitario A Coruña A Coruña Spain
| | - Eduardo Fonseca
- Dermatology DepartmentComplejo Hospitalario Universitario A Coruña A Coruña Spain
- Instituto de Investigación Biomédica de A Coruña (INIBIC) A Coruña Spain
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17
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Soleymani T, Aasi SZ, Novoa R, Hollmig ST. Atypical Fibroxanthoma and Pleomorphic Dermal Sarcoma. Dermatol Clin 2019; 37:253-259. [DOI: 10.1016/j.det.2019.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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18
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Armstrong S, Dwyer P, Bettington A, Strutton G. Brain and lung metastasis secondary to metastatic atypical fibroxanthoma: A rare Australian case. Australas J Dermatol 2019; 58:150-151. [PMID: 28449288 DOI: 10.1111/ajd.12513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Shreya Armstrong
- North Coast Cancer Institute, Radiation Oncology Department, Lismore, New South Wales,, Australia
| | - Patrick Dwyer
- North Coast Cancer Institute, Radiation Oncology Department, Lismore, New South Wales,, Australia
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Abstract
This article reviews the most common nonmelanoma skin cancers affecting the head and neck region. Although the most common of these malignancies rarely result in mortality, local morbidity caused by the tumors and their extirpation cannot be underestimated. Complete tumor extirpation with pathologically confirmed negative margins is the gold standard. Regional and distant metastases are rare, but must be treated appropriately should they occur. Although reconstructive surgery can be life changing for the patients and rewarding for the clinicians, it behooves the treating surgeons to remain true to oncologic principles above all else.
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Affiliation(s)
- Michael G Brandt
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Toronto, 190 Elizabeth Street, Room 3S-438, TGH RFE Building, Toronto, Ontario M5G 2C4, Canada.
| | - Corey C Moore
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine, Western University, St Joseph's Hospital, 268 Grosvenor Street 2nd Floor, London, Ontario N6A 4V2, Canada
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Murray C, Sivajohanathan D, Hanna TP, Bradshaw S, Solish N, Moran B, Hekkenberg R, Wei AC, Petrella T. Patient indications for Mohs micrographic surgery: a clinical practice guideline. ACTA ACUST UNITED AC 2019; 26:e94-e99. [PMID: 30853814 DOI: 10.3747/co.26.4439] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective The purpose of the present work was to develop evidence-based indications for Mohs micrographic surgery in patients with a diagnosis of skin cancer. Methods The guideline was developed by Cancer Care Ontario's Program in Evidence-Based Care, together with the Melanoma Disease Site Group and the Surgical Oncology Program, through a systematic review of relevant literature, patient- and caregiver-specific consultation, and internal and external reviews. Recommendation 1 Given a lack of high-quality, comparative evidence, surgery (with postoperative or intraoperative margin assessment) or radiation (for those who are ineligible for surgery) should remain the standard of care for patients with skin cancer. Recommendation 2 Mohs micrographic surgery is recommended for patients with histologically confirmed recurrent basal cell carcinoma of the face and is appropriate for primary basal cell carcinomas of the face that are larger than 1 cm, have aggressive histology, or are located on the H zone of the face. Recommendation 3 Mohs micrographic surgery should be performed by physicians who have completed a degree in medicine or equivalent, including a Royal College of Physicians and Surgeons of Canada Specialist Certificate or equivalent, and have received advanced training in Mohs micrographic surgery.
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Affiliation(s)
- C Murray
- Division of Dermatology, Women's College Hospital, and University of Toronto, Toronto, ON
| | - D Sivajohanathan
- Department of Oncology, McMaster University, and Program in Evidence-Based Care, Cancer Care Ontario, Hamilton, ON
| | - T P Hanna
- Department of Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston, ON
| | | | - N Solish
- Division of Dermatology, Women's College Hospital, and University of Toronto, Toronto, ON
| | - B Moran
- Division of Dermatology, Queen's University, Kingston, ON
| | - R Hekkenberg
- Department of Surgery, Royal Victoria Regional Health Centre, and Surgical Oncology Program, Cancer Care Ontario, Barrie, ON
| | - A C Wei
- Quality and Knowledge Transfer, Surgical Oncology Program, Cancer Care Ontario, Toronto and, ON
| | - T Petrella
- Department of Medical Oncology, Odette Cancer Centre, Toronto, ON
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Murray C, Sivajohanathan D, Hanna TP, Bradshaw S, Solish N, Moran B, Hekkenberg R, Wei AC, Petrella T. Patient Indications for Mohs Micrographic Surgery: A Systematic Review. J Cutan Med Surg 2018; 23:75-90. [PMID: 30033747 DOI: 10.1177/1203475418786208] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The purpose of the present review was to describe evidence-based indications for Mohs micrographic surgery (MMS) in patients with a diagnosis of skin cancer. Relevant studies were identified from a systematic MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews search of studies published from 1970 to 2017. Randomized controlled trials (RCTs), prospective and retrospective comparative studies with greater than 30 patients, and single-arm retrospective studies with multivariate analyses were included. A total of 2 RCTs, 3 prospective studies, and 16 retrospective studies (14 comparative and 2 single-arm) were included. Data on recurrence rate, cure rate, complications, cosmesis, and quality of life were extracted. Surgery (with postoperative or intraoperative marginal assessment) or radiation for those who are ineligible for surgery should remain the standard of care for patients with skin cancer given the lack of high-quality, comparative evidence. MMS is recommended for those with histologically confirmed recurrent basal cell carcinoma (BCC) of the face and is appropriate for primary BCCs of the face that are >1 cm, have aggressive histology, or are located on the H zone of the face. The available evidence is difficult to generalize to all patients with skin cancer because the evidence did not adequately cover non-BCC skin cancers; however, those skin cancers can be considered on a case-by-case basis for MMS. MMS should be performed by physicians who have completed a degree in medicine or equivalent, including a Royal College of Physicians and Surgeons of Canada Specialist Certificate or equivalent, and have received advanced training in MMS.
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Affiliation(s)
- Christian Murray
- 1 Division of Dermatology, Women's College Hospital & University of Toronto, Toronto, ON, Canada
| | - Duvaraga Sivajohanathan
- 2 Department of Oncology, McMaster University & Program in Evidence-Based Care, Cancer Care Ontario, Hamilton, ON, Canada
| | - Timothy P Hanna
- 3 Department of Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston, ON, Canada
| | | | - Nowell Solish
- 1 Division of Dermatology, Women's College Hospital & University of Toronto, Toronto, ON, Canada
| | - Benvon Moran
- 5 Division of Dermatology, Queen's University, Kingston, ON, Canada
| | - Robert Hekkenberg
- 6 Department of Surgery, Royal Victoria Regional Health Centre & Surgical Oncology Program, Cancer Care Ontario, Barrie, ON, Canada
| | - Alice C Wei
- 7 Quality and Knowledge Transfer, Surgical Oncology Program, Cancer Care Ontario, Toronto, ON, Canada
| | - Teresa Petrella
- 8 Department of Medical Oncology, Odette Cancer Centre, Toronto, ON, Canada
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Abstract
Pleomorphic dermal sarcoma (PDS) is a rare mesenchymal tissue tumor. Distinguishing PDS from similar conditions, such as atypical fibroxanthoma (AFX), its less aggressive tumor counterpart, is difficult, as they are clinically and histologically similar. We present a case of a 77-year-old man presenting with a large nodular scalp lesion of three weeks duration. Pathology revealed a 3.3 cm invasive pleomorphic dermal sarcoma. Surgical excision with 2 cm margins was performed with successful healing of the graft. This case highlights a rare case of a large pleomorphic dermal sarcoma and discusses the histological features and management of PDS.
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Affiliation(s)
| | - Mai P Hoang
- Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, USA
| | - Bobby Y Reddy
- Dermatology, Massachusetts General Hospital, Boston, USA
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Tolkachjov SN, Kelley BF, Alahdab F, Erwin PJ, Brewer JD. Atypical fibroxanthoma: Systematic review and meta-analysis of treatment with Mohs micrographic surgery or excision. J Am Acad Dermatol 2018; 79:929-934.e6. [PMID: 29981390 DOI: 10.1016/j.jaad.2018.06.048] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/16/2018] [Accepted: 06/22/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Atypical fibroxanthoma (AFX) is a fibrohistiocytic tumor with relatively high local recurrence rates but low metastatic potential. Wide local excision (WLE) and Mohs micrographic surgery (MMS) are common treatments, although no consensus exists regarding optimal therapy. OBJECTIVE To systematically review evidence of AFX recurrence and metastatic rates after different surgical modalities. METHODS A comprehensive search was performed for articles published from 1946 or database inception to March 20, 2017. Studies selected included those that had 5 or more patients with atypical fibroxanthoma treated surgically. Two reviewers independently abstracted the data. Risk of bias was assessed with the Newcastle-Ottawa scale. Main outcomes and measures included recurrence and metastasis. RESULTS In total, 23 studies were selected (907 patients and 914 tumors); 175 patients were treated with MMS (recurrence rate 2.0%, 95% confidence interval [CI] 0%-4.1%; metastatic rate 1.9%, 95% CI 0.1%-3.8%), and 732 were treated with WLE (recurrence rate 8.7%, 95% CI 5%-12.3%; metastasis rate 1%, 95% CI 0.2%-1.9%). Among immunocompromised patients, no recurrence or metastases developed in the MMS subgroup, although 4 of 10 recurred and 1 of 10 metastasized in the WLE subgroup. LIMITATIONS Low quality of the studies published. CONCLUSION MMS for atypical fibroxanthoma is associated with a lower recurrence rate than WLE.
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Affiliation(s)
| | | | - Fares Alahdab
- Mayo Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota
| | - Patricia J Erwin
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Jerry D Brewer
- Division of Dermatologic Surgery, Mayo Clinic, Rochester, Minnesota
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Chen ELA, Srivastava D, Nijhawan RI. Mohs Micrographic Surgery: Development, Technique, and Applications in Cutaneous Malignancies. Semin Plast Surg 2018; 32:60-68. [PMID: 29765269 DOI: 10.1055/s-0038-1642057] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Mohs micrographic surgery (MMS) is a specialized technique for treating skin malignancies that offers the highest cure rate by allowing histological evaluation of the entire peripheral and deep margins. MMS also maximally preserves as much uninvolved, normal adjacent tissue as possible, allowing for the best cosmetic and functional outcomes. When used for appropriate indications, this technique is also more cost-effective than other treatment modalities. In this article, the authors will discuss the development of MMS, the steps involved in this procedure, and the indications for this technique. They will also review the use of MMS for basal cell carcinoma, squamous cell carcinoma, melanoma in situ, and some less common skin malignancies.
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Affiliation(s)
- Eillen Luisa A Chen
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Divya Srivastava
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
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Conception and Management of a Poorly Understood Spectrum of Dermatologic Neoplasms: Atypical Fibroxanthoma, Pleomorphic Dermal Sarcoma, and Undifferentiated Pleomorphic Sarcoma. Curr Treat Options Oncol 2018; 18:50. [PMID: 28762020 DOI: 10.1007/s11864-017-0489-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OPINION STATEMENT Atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS) tumors share many clinical, etiologic, and histologic features and likely represent components of a tumor spectrum. In dermatologic oncology, differentiating between AFX and PDS is pivotal as tumors with histological features consistent with PDS are more likely to behave in a clinically aggressive manner. Importantly, the term "pleomorphic dermal sarcoma" (PDS) is a more appropriate designation than "undifferentiated pleomorphic sarcoma" (UPS) for describing deeper, more aggressive, histologically high-grade cutaneous tumors that otherwise resemble AFX. Surgery remains the gold standard for treatment. In the setting of AFX, excision with the Mohs micrographic technique appears to offer superior tumor control rates while maintaining greater tissue preservation over wide local excision and should be considered first line. In the setting of PDS, optimal management is less clear given the paucity of available data. However, due to its greater propensity to recur and metastasize, extirpation with complete tumor margin control appears paramount. The roles of imaging and SLNB in management and clinical outcomes of AFX and PDS are unclear given the lack of available data. In reality, these tools are unlikely to be helpful in most cases of AFX. However, in the setting of PDS, emerging literature indicates that these tumors are inherently higher risk, and thus, imaging and SLNB may be helpful in select cases. Additionally, radiation therapy may be of adjuvant benefit for these tumors when clear surgical margins cannot be obtained. While traditional chemotherapy has been largely ineffectual, the recent discovery of key oncogenetic mutations has allowed for the identification of several potential molecular drug targets that may have a therapeutic role with future study. In the unfortunate setting of metastatic disease, a multidisciplinary approach is optimal. Further studies are needed to establish definitive conclusions regarding risk stratification and best management practices.
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Polcz MM, Sebaratnam DF, Fernández-Peñas P. Atypical fibroxanthoma management: Recurrence, metastasis and disease-specific death. Australas J Dermatol 2017; 59:10-25. [DOI: 10.1111/ajd.12646] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/06/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Margit Marisa Polcz
- Skin and Cancer Foundation; Sydney New South Wales Australia
- Department of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Deshan Frank Sebaratnam
- Skin and Cancer Foundation; Sydney New South Wales Australia
- Department of Dermatology; University of Sydney; Sydney New South Wales Australia
| | - Pablo Fernández-Peñas
- Skin and Cancer Foundation; Sydney New South Wales Australia
- Department of Dermatology; University of Sydney; Sydney New South Wales Australia
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Tolkachjov SN, Brodland DG, Coldiron BM, Fazio MJ, Hruza GJ, Roenigk RK, Rogers HW, Zitelli JA, Winchester DS, Harmon CB. Understanding Mohs Micrographic Surgery: A Review and Practical Guide for the Nondermatologist. Mayo Clin Proc 2017; 92:1261-1271. [PMID: 28778259 DOI: 10.1016/j.mayocp.2017.04.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 04/05/2017] [Accepted: 04/14/2017] [Indexed: 12/30/2022]
Abstract
The incidence and diagnosis of cutaneous malignancies are steadily rising. In addition, with the aging population and increasing use of organ transplant and immunosuppressive medications, subsets of patients are now more susceptible to skin cancer. Mohs micrographic surgery (MMS) has become the standard of care for the treatment of high-risk nonmelanoma skin cancers and is increasingly used to treat melanoma. Mohs micrographic surgery has the highest cure rates, spares the maximal amount of normal tissue, and is cost-effective for the treatment of cutaneous malignancies. As in other medical fields, appropriate use criteria were developed for MMS and have become an evolving guideline for determining which patients and tumors are appropriate for referral to MMS. Patients with cutaneous malignancies often require multidisciplinary care. With the changing landscape of medicine and the rapidly increasing incidence of skin cancer, primary care providers and specialists who do not commonly manage cutaneous malignancies will need to have an understanding of MMS and its role in patient care. This review better familiarizes the medical community with the practice of MMS, its utilization and capabilities, differences from wide excision and vertical section pathology, and cost-effectiveness, and it guides practitioners in the process of appropriately evaluating and determining when patients with skin cancer might be appropriate candidates for MMS.
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Affiliation(s)
| | - David G Brodland
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA; Zitelli & Brodland, P.C., Pittsburgh, PA
| | - Brett M Coldiron
- The Skin Cancer Center, Cincinnati, OH; Department of Dermatology, University of Cincinnati, Cincinnati, OH
| | | | - George J Hruza
- Department of Dermatology, St Louis University, St Louis, MO; Laser & Dermatologic Surgery Center, Chesterfield, MO
| | - Randall K Roenigk
- Department of Dermatology, Mayo Clinic, Rochester, MN; Division of Dermatologic Surgery, Mayo Clinic, Rochester, MN
| | | | - John A Zitelli
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA; Zitelli & Brodland, P.C., Pittsburgh, PA
| | - Daniel S Winchester
- Department of Dermatology, Mayo Clinic, Rochester, MN; Division of Dermatologic Surgery, Mayo Clinic, Rochester, MN
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Prewett S, Horan G, Hatcher H, Ajithkumar T. Borderline Sarcomas and Smooth Muscle Tumours of Uncertain Malignant Potential. Clin Oncol (R Coll Radiol) 2017; 29:528-537. [PMID: 28595873 DOI: 10.1016/j.clon.2017.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 05/11/2017] [Accepted: 05/11/2017] [Indexed: 12/22/2022]
Abstract
Borderline sarcomas and smooth muscle tumours of uncertain malignant potential (STUMP) have an unpredictable clinical behaviour with frequent local recurrences and rarely, metastases. We review the current management of common subtypes of borderline sarcomas and STUMP.
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Affiliation(s)
- S Prewett
- Cambridge University Hospital, Cambridge, UK
| | - G Horan
- Cambridge University Hospital, Cambridge, UK
| | - H Hatcher
- Cambridge University Hospital, Cambridge, UK
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Incidence and Clinical Features of Rare Cutaneous Malignancies in Olmsted County, Minnesota, 2000 to 2010. Dermatol Surg 2017; 43:116-124. [PMID: 28027201 DOI: 10.1097/dss.0000000000000936] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The incidence of rare cutaneous malignancies is unknown. Current estimates of rare cutaneous malignancy incidences are based on broad epidemiologic data or single institution experiences, not population-based data. OBJECTIVE To determine the incidence of several rare nonmelanoma skin cancers. MATERIALS AND METHODS The authors conducted a retrospective chart review of a population-based cohort between the years 2000 and 2010. Residents of Olmsted County, Minnesota, who were diagnosed with a biopsy-proven nonmelanoma skin cancer-excluding basal cell carcinoma and squamous cell carcinoma-were included in this study. The primary outcome was tumor incidence. Additionally, the authors extracted patient demographics, tumor characteristics, treatment modalities, and outcomes. RESULTS The age-adjusted and sex-adjusted incidences per 100,000 persons of multiple rare cutaneous malignancies were: atypical fibroxanthoma (1.8), sebaceous carcinoma (0.8), dermatofibrosarcoma protuberans (0.4), microcystic adnexal carcinoma (0.7), eccrine carcinoma (0.4), eccrine porocarcinoma (0.2), and leiomyosarcoma (0.2). CONCLUSION The authors report population-based incidences and clinical characteristics for these rare cutaneous malignancies. The immune status and smoking status of patients and the treatment and outcomes of these tumors are reported. Additional studies in a broader population are needed to further define the epidemiology and outcomes of these malignancies.
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Electronic brachytherapy management of atypical fibroxanthoma: report of 8 lesions. J Contemp Brachytherapy 2017; 9:158-160. [PMID: 28533805 PMCID: PMC5437075 DOI: 10.5114/jcb.2017.65454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 01/07/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose To evaluate the suitability of treating atypical fibroxanthoma (AFX), an uncommon skin malignancy, with electronic brachytherapy. Material and methods From Feb 2013 to Sep 2014, we were referred a total of 8 cases of AFX in 7 patients, all involving the scalp. All of them were treated with electronic brachytherapy 50 Kev radiations (Xoft Axxent®, Fremont, California). All lesions received 40 Gy in two fractions per week with 5mm margins. Results At a median follow-up of 23.7 months, the local recurrence rate is 12.5%. The single lesion that failed was not debulked surgically prior to electronic brachytherapy. Conclusions To our knowledge, this is the first report in the literature on the use of radiation therapy as curative primary treatment for AFX. No contraindication to the use of radiations is found in the literature, with surgery being the sole treatment for AFX noted. Our recurrence rate is 0% for debulked lesions. Risk of recurrence is mitigated with surgical debulking prior to brachytherapy. Electronic brachytherapy appears to be a safe and effective treatment for debulked AFX. Multiple excisions, skin grafting, and wound care can be avoided in elderly patients by the use of electronic brachytherapy.
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Kim JI, Choi YJ, Seo HM, Kim HS, Lim JY, Kim DH, Chae SW, Lee GY, Kim WS. Case of Pleomorphic Dermal Sarcoma of the Eyelid Treated with Micrographic Surgery and Secondary Intention Healing. Ann Dermatol 2016; 28:632-636. [PMID: 27746645 PMCID: PMC5064195 DOI: 10.5021/ad.2016.28.5.632] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 05/09/2016] [Accepted: 05/23/2016] [Indexed: 11/22/2022] Open
Abstract
Pleomorphic dermal sarcoma (PDS) is a rare mesenchymal neoplasm sharing histopathological features with atypical fibroxanthoma (AFX), but has additional features of deep invasion of the superficial subcutis, tumor necrosis and vascular/perineural invasion. It is not well documented in the literature because of its rarity, and its clinical course has been debated due to the lack of homogenous criteria. We describe here the case of a 91-year-old female with a 6-month history of a solitary, asymptomatic, well-defined, 3.4-cm-sized, reddish, hard, protruding mass on the lateral aspect of the right upper eyelid. On the basis of initial punch biopsy results, storiform cellular infiltrate of pleomorphic spindle and polygonal cells with frequent atypical mitoses, the lesion was identified as AFX. Following the initial biopsy, micrographic surgery was performed and a tumor-free margin was confirmed. Considering the conservation of the periocular function and the advanced age of the patient, we planned secondary intention healing rather than primary suturing. After surgery, skeletal muscle infiltration was found and the diagnosis was revised to PDS by a pathologist based on the currently accepted criteria for PDS. There has been no evidence of recurrence or periocular functional defects during a 2-year follow-up without adjuvant therapy. Although the PDS is highly malignant, complete excision under micrographic surgery can prevent recurrence without adjuvant therapy. Also, the secondary intention healing is an effective method for closure of large defects on the face.
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Affiliation(s)
- Jung-In Kim
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Jun Choi
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun-Min Seo
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Han-Saem Kim
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Yun Lim
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Hoon Kim
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seoung Wan Chae
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ga-Young Lee
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won-Serk Kim
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Tongdee E, Touloei K, Shitabata PK, Shareef S, Maranda EL. Keloidal Atypical Fibroxanthoma: Case and Review of the Literature. Case Rep Dermatol 2016; 8:156-63. [PMID: 27462224 PMCID: PMC4943314 DOI: 10.1159/000446343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/20/2016] [Indexed: 11/19/2022] Open
Abstract
Keloidal atypical fibroxanthoma (KAF) has recently been categorized as a variant of atypical fibroxanthoma. This paper will emphasize the importance of including KAF in both clinical and histological differential diagnosis of benign and malignant lesions which exhibit keloidal collagen and will also review the current literature on epidemiology, pathogenesis, histology, immunochemistry and treatments.
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Affiliation(s)
- Emily Tongdee
- Florida International University Herbert Wertheim College of Medicine, Miami, Fla., USA
| | - Khasha Touloei
- Broward Health Medical Center, Fort Lauderdale, Fla., USA
| | - Paul K Shitabata
- Department of Pathology, Western University, Pomona, Calif., USA; Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, Calif., USA; Dermatopathology Institute, Torrance, Calif., USA
| | | | - Eric L Maranda
- University of Miami Miller School of Medicine, Miami, Fla., USA
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Nguyen CM, Chong K, Cassarino D. Clear cell atypical fibroxanthoma: a case report and review of the literature. J Cutan Pathol 2016; 43:538-542. [PMID: 26956561 DOI: 10.1111/cup.12696] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/27/2015] [Accepted: 07/26/2015] [Indexed: 12/20/2022]
Abstract
Atypical fibroxanthoma (AFX) is a group of cutaneous tumors characterized by a population of fusiform, epithelioid and pleomorphic cells. Clinically, AFX is commonly found on the head and neck of older adults as a solitary ulcerated nodule. Clear cell atypical fibroxanthoma is a very rare variant of AFX, with only 13 cases reported to date. The differential diagnoses often include dermal neoplasms composed of clear cells, such as squamous cell carcinoma, basal cell carcinoma, metastatic renal cell carcinoma and balloon cell malignant melanoma. These diagnoses can be ruled out by the typical immunohistochemical profile of clear cell AFX, which is negative for specific epithelial and melanocytic markers. Herein, we describe a rare and unusual case of clear cell AFX arising on the ear of a relatively young adult patient. Histologically, the dermis was completely replaced by an atypical population of vacuolated cells with numerous atypical mitoses. Immunohistochemical stains were negative forpancytokeratin, CK5/6, CK7, and p63 S100 and Melan-A stains. CD10 and CD68 stains were positive, making the findings consistent with the diagnosis of clear cell atypical fibroxanthoma.
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Affiliation(s)
| | - Kim Chong
- Department of Dermatology, Kaiser Permanente, Sunset Medical Center, Los Angeles, CA, USA
| | - David Cassarino
- Department of Dermatology, Kaiser Permanente, Sunset Medical Center, Los Angeles, CA, USA
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Costigan DC, Doyle LA. Advances in the clinicopathological and molecular classification of cutaneous mesenchymal neoplasms. Histopathology 2016; 68:776-95. [PMID: 26763770 DOI: 10.1111/his.12930] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In recent years, there have been several important refinements in the classification of cutaneous mesenchymal neoplasms, including the description of new tumour types, along with the identification of novel and recurrent molecular genetic findings. In addition to providing new insights into tumour biology, many of these advances have had significant clinical consequences with regard to diagnostics, management, and prognostication. Newly described entities include pseudomyogenic haemangioendothelioma, haemosiderotic fibrolipomatous tumour, and fibroblastic connective tissue naevus, which are reviewed in the context of the principal differential diagnoses and significant clinical implications. Genetic characterization of several soft tissue tumour types that occur in the skin has resulted in the identification of diagnostically useful markers: ALK gene rearrangement with corresponding ALK protein expression by immunohistochemistry in epithelioid fibrous histiocytoma; the WWTR1-CAMTA1 fusion gene with CAMTA1 protein expression in epithelioid haemangioendothelioma; MYC amplification and overexpression in radiation-associated angiosarcoma; and EWSR1 gene rearrangement in cutaneous myoepithelial tumours. Finally, the classification of intradermal smooth muscle tumours and unclassified/pleomorphic dermal sarcoma has been refined, resulting in both improved classification and improved prognostication. Many of the tumour types listed above are encountered not only by specialist dermatopathologists, but also by practising general surgical pathologists, and this review should therefore provide a widely applicable update on the histological and molecular classification of cutaneous mesenchymal neoplasms, along with the appropriate use of ancillary diagnostic tests, in particular immunohistochemistry, in the evaluation of such lesions and their histological mimics.
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Affiliation(s)
- Danielle C Costigan
- Department of Histopathology, St James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - Leona A Doyle
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Tardío JC, Pinedo F, Aramburu JA, Suárez-Massa D, Pampín A, Requena L, Santonja C. Pleomorphic dermal sarcoma: a more aggressive neoplasm than previously estimated. J Cutan Pathol 2015; 43:101-12. [PMID: 26264237 DOI: 10.1111/cup.12603] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 03/19/2015] [Accepted: 06/23/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pleomorphic dermal sarcoma (PDS) is a rare neoplasm sharing pathological features with atypical fibroxanthoma, but adding tumor necrosis, invasion beyond superficial subcutis or vascular or perineural infiltration. Although its metastatic risk has been estimated to be less than 5%, its real outcome is presently uncertain because of its rarity and to the lack of homogeneous criteria used in reported cases. METHODS Retrospective clinicopathological study of 18 cases of PDS. RESULTS The lesions presented as tumors or plaques (size: 7-70 mm) on the head of elderly patients (median: 81 years), without a gender predominance. Histopathologically, they consisted of spindle cells arranged in a fascicular pattern, containing pleomorphic epithelioid and giant multinucleated cells in varying proportions, and usually exhibiting numerous mitotic figures and infiltrative tumor margins. No immunoexpression for cytokeratins, S100 protein, desmin or CD34 was observed. Necrosis and venous invasion were found in three tumors each (17%). Follow-up was available in 15 cases (median: 33 months). Three patients (20%) had local recurrences, all with incomplete primary surgical resections. Three patients (20%) developed distant metastases in the skin, regional lymph nodes and/or lungs and died from the disease. CONCLUSION Our data suggest that PDS may be a more aggressive neoplasm than previously estimated.
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Affiliation(s)
- Juan C Tardío
- Department of Pathology, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Fernando Pinedo
- Department of Pathology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - José A Aramburu
- Department of Pathology, Hospital Universitario de Getafe, Madrid, Spain
| | - Dolores Suárez-Massa
- Department of Pathology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Ana Pampín
- Department of Dermatology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Luis Requena
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Carlos Santonja
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.,Department of Pathology, Hospital Universitario Infanta Sofía de San Sebastián de los Reyes, Madrid, Spain
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41
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Lee SS, Lewis JM, Liaw K, Bushkell Jr LL, Young YD, Googe PB. Recurrent atypical fibroxanthoma with satellite metastasis. J Cutan Pathol 2014; 42:56-60. [DOI: 10.1111/cup.12447] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 06/16/2014] [Accepted: 10/27/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Solomon S. Lee
- Department of Pathology; University of Tennessee Graduate School of Medicine; Knoxville TN USA
| | - James M. Lewis
- Department of Surgery; University of Tennessee Graduate School of Medicine; Knoxville TN USA
| | - Kevin Liaw
- Department of Radiology; University of Tennessee Graduate School of Medicine; Knoxville TN USA
| | | | - Yorke D. Young
- Department of Pathology; University of Tennessee Graduate School of Medicine; Knoxville TN USA
| | - Paul B. Googe
- Department of Pathology; University of Tennessee Graduate School of Medicine; Knoxville TN USA
- Knoxville Dermatopathology Laboratory; Knoxville TN USA
- Department of Pathology; Vanderbilt University; Nashville TN USA
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42
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[Atypical fibroxanthoma]. Ann Dermatol Venereol 2014; 141:786-9. [PMID: 25433934 DOI: 10.1016/j.annder.2014.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 04/29/2014] [Accepted: 05/19/2014] [Indexed: 11/20/2022]
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Abstract
Atypical fibroxanthoma (AFX) is an ultraviolet radiation-associated dermal neoplasm. To address the clinicopathologic and molecular features of this particular neoplasm. The author conducted a literature review using PubMed searching for articles relating to AFX. AFX usually appears as a rapidly growing nodular or nodulo-ulcerative lesion. It occurs on sun-exposed skin of elderly peoples. AFX may be composed predominantly of pleomorphic, spindle, epithelioid cells, or admixture of these cells. The differential diagnosis of AFX includes pleomorphic dermal sarcoma, squamous cell carcinoma, malignant melanoma and leiomyosarcoma. Several observations favor a mesenchymal origin for AFX. These reviews address the clinicopathologic features, molecular pathology, prognosis and treatment of this neoplasm.
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Wollina U, Schönlebe J, Ziemer M, Friedling F, Koch A, Haroske G, Kaatz M, Simon JC. Atypical fibroxanthoma: A series of 56 tumors and an unexplained uneven distribution of cases in southeast Germany. Head Neck 2014; 37:829-34. [DOI: 10.1002/hed.23673] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 12/10/2013] [Accepted: 03/06/2014] [Indexed: 11/12/2022] Open
Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Hospital Dresden-Friedrichstadt; Academic Teaching Hospital of the Technical University of Dresden; Dresden Germany
| | - Jaqueline Schönlebe
- Institute of Pathology “Georg Schmorl,” Hospital Dresden-Friedrichstadt; Academic Teaching Hospital of the Technical University of Dresden; Dresden Germany
| | - Mirjana Ziemer
- Department of Dermatology, Venereology, and Allergology; University of Leipzig; Leipzig Germany
| | | | - André Koch
- Department of Dermatology and Allergology, Hospital Dresden-Friedrichstadt; Academic Teaching Hospital of the Technical University of Dresden; Dresden Germany
| | - Gunter Haroske
- Institute of Pathology “Georg Schmorl,” Hospital Dresden-Friedrichstadt; Academic Teaching Hospital of the Technical University of Dresden; Dresden Germany
| | - Martin Kaatz
- Department of Dermatology and Allergology; SHR-Waldklinikum; Gera Germany
| | - Jan-C. Simon
- Department of Dermatology, Venereology, and Allergology; University of Leipzig; Leipzig Germany
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45
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Hanke CW, Moy RL, Roenigk RK, Roenigk HH, Spencer JM, Tierney EP, Bartus CL, Bernstein RM, Brown MD, Busso M, Carruthers A, Carruthers J, Ibrahimi OA, Kauvar ANB, Kent KM, Krueger N, Landau M, Leonard AL, Mandy SH, Rohrer TE, Sadick NS, Wiest LG. Current status of surgery in dermatology. J Am Acad Dermatol 2013; 69:972-1001. [PMID: 24099730 DOI: 10.1016/j.jaad.2013.04.067] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 04/16/2013] [Accepted: 04/17/2013] [Indexed: 02/08/2023]
Abstract
An article titled "Current issues in dermatologic office-based surgery" was published in the JAAD in October 1999 (volume 41, issue 4, pp. 624-634). The article was developed by the Joint American Academy of Dermatology/American Society for Dermatologic Surgery Liaison Committee. A number of subjects were addressed in the article including surgical training program requirements for dermatology residents and selected advances in dermatologic surgery that had been pioneered by dermatologists. The article concluded with sections on credentialing, privileging, and accreditation of office-based surgical facilities. Much has changed since 1999, including more stringent requirements for surgical training during dermatology residency, and the establishment of 57 accredited Procedural Dermatology Fellowship Training Programs. All of these changes have been overseen and approved by the Residency Review Committee for Dermatology and the Accreditation Committee for Graduate Medical Education. The fertile academic environment of academic training programs with interaction between established dermatologic surgeons and fellows, as well as the inquisitive nature of many of our colleagues, has led to the numerous major advances in dermatologic surgery, which are described herein.
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46
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Atypical fibroxanthoma with pseudoangiomatous features: a histological and immunohistochemical mimic of cutaneous angiosarcoma. Ann Diagn Pathol 2013; 17:502-7. [PMID: 24080496 DOI: 10.1016/j.anndiagpath.2013.08.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 08/22/2013] [Accepted: 08/22/2013] [Indexed: 12/20/2022]
Abstract
Atypical fibroxanthoma and pleomorphic dermal sarcoma may be difficult to separate from cutaneous angiosarcoma. We aim to study the morphological spectrum of pseudoangiomatous features in these tumors and the value of staining for endothelial markers CD31, CD34, FLI1, and ERG. Eleven atypical fibroxanthomas and 3 pleomorphic dermal sarcomas were identified. All tumors arose on sun-damaged skin of elderly men. Atypical fibroxanthomas were nodular and confined to the dermis, whereas pleomorphic dermal sarcoma invaded into underlying fascia. All tumors were composed of pleomorphic epithelioid and spindle cells showing blood-filled spaces and intratumoral hemorrhage. Intracytoplasmic vacuoles (n = 4), hemosiderin deposition (n = 2), and keloidal stromal change (n = 1) were also noted. Immunohistochemically, CD31 was expressed in 43% of cases, FLI1 in 79% and smooth muscle actin in 50%. Staining for CD34, ERG, S100, HMB-45, desmin, p63 and cytokeratins was negative. Follow up (median, 43.1 months; range 1-100), available for 10 patients, showed no adverse outcome. Pseudoangiomatous features and aberrant expression of CD31 and FLI1 in atypical fibroxanthoma and pleomorphic dermal sarcoma may lead to an erroneous diagnosis of cutaneous angiosarcoma. Negativity for CD34 and ERG, in particular, is a reliable differentiating feature in this setting.
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47
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Abstract
Nonmelanoma skin cancer (NMSC) is the most common form of malignancy in humans. The incidence of NMSC continues to increase despite increased awareness and sun-protective measures. If neglected or mismanaged, NMSC can cause significant morbidity and even death. The most common forms of NMSC on the head and neck include basal cell carcinoma, squamous cell carcinoma, sebaceous carcinoma, eccrine porocarcinoma, Merkel cell carcinoma, atypical fibroxanthoma, and microcystic adnexal carcinoma. Surgery is the mainstay of treatment (standard excision, Mohs micrographic surgery, curettage); however, other modalities exist, including radiation, topical immunomodulators, photodynamic therapy, and new systemic medications.
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Affiliation(s)
- Lauren E Dubas
- Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
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49
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Lee S, Joo KB, Park CK, Kim TS, Bae J. A case of atypical fibroxanthoma of subungual type: ultrasound and magnetic resonance imaging findings. Clin Imaging 2012. [PMID: 23206624 DOI: 10.1016/j.clinimag.2012.01.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Subungual atypical fibroxanthoma is a rare mesenchymal skin tumor of intermediate malignancy. It classically presents as a relatively nondescript, erythematous nodule; it may ulcerate and bleed, but pain and pruritus are uncommon. In the differential diagnoses of subungual tumors, glomus tumor, soft tissue chondroma, keratoacanthoma, hemangioma, lobular capillary hemangioma, epidermal and mucoid cysts, squamous cell carcinoma, and malignant melanoma have been suggested. But atypical fibroxanthoma has not been included in the differential diagnoses. We report a case that occurred in a 56-year-old man with subungual atypical fibroxanthoma mimicking malignant soft tissue tumor in the right fifth toe.
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Affiliation(s)
- Seunghun Lee
- Department of Radiology, Hanyang University Hospital, Seoul 133-792, Korea
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50
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Malignant fibrous histiocytoma: Changing perceptions and management challenges. J Am Acad Dermatol 2012; 67:1335-41. [DOI: 10.1016/j.jaad.2012.04.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 04/04/2012] [Accepted: 04/08/2012] [Indexed: 11/17/2022]
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