Cutaneous leiomyosarcoma: A rare cutaneous soft tissue neoplasm. Clinicopathologic Features and Review of Literature
Main Article Content
Abstract
Leiomyosarcomas of the skin are divided into two subtypes based on their origin and location: superficial dermal leiomyosarcoma believed to originate from the arrector pili muscles and sweat glands, and subcutaneous leiomyosarcoma arising from vascular smooth muscle of subcutaneous adipose tissue. Preoperative misdiagnosis is common because it is a rare malignant tumor, and the diagnosis is based on histopathological and immunohistochemical studies. Although superficial cutaneous leiomyosarcoma is usually treated with surgical excision, high rates of local recurrence (30–50%) have been reported. Subcutaneous leiomyosarcomas tend to be more aggressive, and since they are usually diagnosed at a more advanced stage, they are usually larger than superficial dermal based neoplasms. Recurrence rates are higher at 50–70%, and up to 60% of distant metastases have been reported. Guidelines for surgical management and role of radiation and chemotherapy as adjuvant treatments are not clearly defined. The clinicopathological features of this rare cutaneous soft tissue neoplasm are described, along with a review of the literature. Differential diagnoses, possible histogenesis, clinical behavior, management, and prognostic factors are also discussed.
Keywords:
Cutaneous leiomyosarcoma, smooth muscle tumor, cutaneous neoplasm, dermatopathology
Article Details
How to Cite
TINGURIA, Mukund.
Cutaneous leiomyosarcoma: A rare cutaneous soft tissue neoplasm. Clinicopathologic Features and Review of Literature.
Medical Research Archives, [S.l.], v. 13, n. 4, apr. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6437>. Date accessed: 15 may 2025.
doi: https://doi.org/10.18103/mra.v13i4.6437.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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2. Stout A, Hill W. Leiomyosarcoma of the superficial soft tissue. Cancer 1964; 11: 844.
3. Liao W, Wang Y, Ma H. Cutaneous leiomyosarcoma: the clinical experience of Taipei veterans general hospital revisited. Ann Plast Surg 2017; 78(3 Suppl 2): S47–S51.
4. Massi D, Franchi A, Alos L, et al. Primary cutaneous leiomyosarcoma: clinicopathological analysis of 36 cases. Histopathology. 2010;56:251–262.
5. Kraft S, Fletcher C. Atypical intradermal smooth muscle neoplasms: clinicopathologic analysis of 84 cases and a reappraisal of cutaneous “leiomyosarcoma”. Am J Surg Pathol. 2011;35:599–607
6.Fields J, Helwig E. Leiomyosarcoma of the skin and subcutaneous tissue. Cancer. 1981;47:156–169.
7. Snowden R, Osborn F, Wong F. et al. Superficial leiomyosarcoma of the head and neck: case report and review of the literature. Ear Nose Throat J. 2001; 80; 449–453
8. Kaddu S, Beham A, Cerroni L. et al. Cutaneous leiomyosarcoma. Am. J. Surg. Pathol. 1997; 21; 979–987
9. Annest N, Grekin S, Stone M. et al. Cutaneous leiomyosarcoma: a tumor of the head and neck. Dermatol. Surg. 2007; 33; 628–633.
10. González-Sixto B, De la Torre C, Pardavila R. et al. Leiomyosarcoma arising from scrofuloderma scar. Clin Exp Dermatol. 2008;33:776–778
11. West C, Morritt A, Pedelty L. et al. Cutaneous leiomyosarcoma arising in a tattoo—‘a tumour with no humour’. J Plast Reconstr Aesthet Surg. 2009;62: e79
12. González-Vela M, Val-Bernal J, Rubio S. et al. Cutaneous leiomyosarcoma developing on a pacemaker pocket. Dermatol Surg. 2009 ;35 :863–867.
13. Pol R, Dannenberg H, Robertus J. et al. Cutaneous leiomyosarcoma arising in a smallpox scar. World J Surg Oncol. 2012;10:148.
14. Weiss S, Goldblum J. Enzinger and Weiss's Soft Tissue Tumors. 6th ed. Saunders; 2013
15.Holst V, Junkins-Hopkins J, Elenitsas R. Cutaneous smooth muscle neoplasms: clinical features, histologic findings, and treatment options. J Am Acad Dermatol. 2002;46:477–490.
16. Pijpe J, Broers G, Plaat B. et al. The relation between histological, tumor biological and clinical parameters in deep and superficial leiomyosarcoma and leiomyoma. Sarcoma. 2002;6:105–110.
17. Fons M, Bachhuber T, Plaza J. Cutaneous leiomyosarcoma originating in a symplastic pilar leiomyoma: a rare occurrence and potential diagnostic pitfall. J Cutan Pathol. 2011;38:49–53.
18. Winchester D, Hocker T, Brewer J. et al. Leiomyosarcoma of the skin: clinical, histopathologic, and prognostic factors that influence outcomes. J Am Acad Dermatol. 2014;71:919–925
19. Blaise G, Nikkels A. Childhood cutaneous leiomyosarcoma. Pediatr Dermatol. 2009; 26:477–479.
20. Bellezza G, Sidoni A, Cavaliere A. et al. Primary cutaneous leiomyosarcoma: a clinicopathological and immunohistochemical study of 7 cases. Int J Surg Pathol. 2004;12:39–44.
21. Bernstein S, Roenigk R. Leiomyosarcoma of the skin. Treatment of 34 cases. Dermatol Surg. 1996; 22:631–635.
22. Yanguas I, Goday J, González-Güemes M. et al. Cutaneous leiomyosarcoma in a child. Pediatr Dermatol. 1997; 14:281–283.
23. Miyajima K, Oda Y, Oshiro Y. et al. Clinicopathological prognostic factors in soft tissue leiomyosarcoma: a multivariate analysis. Histopathology. 2002;40: 353–359.
24. Oliver G, Reiman H, Gonchoroff N. et al. Cutaneous and subcutaneous leiomyosarcoma: a clinicopathological review of 14 cases with reference to antidesmin staining and nuclear DNA patterns studied by flow cytometry. Br J Dermatol. 1991;124:252–257
25. Christopher J, Porter M, Januszkiewicz J. Cutaneous leiomyosarcoma. Plast Reconstr Surg. 2002 ;109 :964–967
26. Iacobucci J, Stevenson T, Swanson N, et al. Cutaneous leiomyosarcoma. Ann Plast Surg. 1987;19:552–554.
27. Lin J, Tsai R. Subcutaneous leiomyosarcoma on the face. Dermatol Surg. 1999;25:489–491.
28. Tsutsumida A, Yoshida T, Yamamoto Y. Management of superficial leiomyosarcoma: a retrospective study of 10 cases. Plast Reconstr Surg. 2005; 116:8–12.
29. Starling J, Coldiron BM. Mohs micrographic surgery for the treatment of cutaneous leiomyosarcoma. J Am Acad Dermatol. 2011;64:1119–1122.
30. Deneve J, Messina J, Bui M, et al. Cutaneous leiomyosarcoma: treatment and outcomes with a standardized margin of resection. Cancer Control. 2013; 20:307–312.
31. Llombart B, Serra-Guillén C, Requena C. et al. Leiomyosarcoma and pleomorphic dermal sarcoma: guidelines for diagnosis and treatment. Actas Dermosifiliogr. 2019;110:4 – 11
32. Kohlmeyer J, Steimle-Grauer S, Hein R. Cutaneous sarcomas. J Dtsch Dermatol Ges. 2017;15:630 – 48
33. John T, Portenier D, Auster B. et al. Leiomyosarcoma of the scrotum – a case report and review of the literature. Urology 2006;67(2):424e13–15.
34. Torres T, Oliveira A, Sanches M. et al. Superficial cutaneous leiomyosarcoma of the face: report of three cases. J Dermatol. 2011;38:373– 376.
35. Taylor M, Thomas S, Ituarte B. et al. Sex disparities in leiomyosarcoma of the skin: females experience worse disease‑specific survival. Archives of Dermatological Research (2024) 316:469
36. Zaballos P, Del Pozo L, Argenziano G. et al. Dermoscopy of cutaneous smooth muscle neoplasms: a morphological study of 136 cases. J Eur Acad Dermatol Venereol 2019; 33: 693–699.
37. Dahl I, Angervall L. Cutaneous and subcutaneous leiomyosarcoma: a clinicopathologic study of 47 patients. Pathol Eur. 1974;9: 307–315.
38. Davidson L, Frost M, Hanke W. et al. Primary leiomyosarcoma of the skin: case report and review of the literature. J Am Acad Dermatol 1989;21:1156–60.
39. Aneiros-Fernandez J, Antonio Retamero J, Husein-Elahmed H. et al. Primary cutaneous and subcutaneous leiomyosarcomas: review of their evolution and prognostic factors. Eur J Dermatol 2016; 26(1): 9-12 doi:10.1684/ejd.2015.2681
40. Weedon D, Williamson R, Patterson J. Smooth and skeletal muscle tumours. World Health Organization classification of tumours. Pathology & genetics. Skin tumours. Lyon: IARC Press, 2006; 250–253
41. Idriss M, Kazlouskaya V, Malhotra S. et al. Phosphohistone- H3 and Ki-67 immunostaining in cutaneous pilar leiomyoma and leiomyosarcoma (atypical intradermal smooth muscle neoplasm). J Cutan Pathol 2013 ; 40 : 557–563
42. Atzori L, Pilloni L, Zanniello R. et al. Clear-cell variant of superficial cutaneous leiomyosarcoma associated with RB1 mutation: Clinical, dermoscopic, and histopathological characteristics. J Cutan Pathol. 2020;47:571–575.
43. Choy C, Cooper A, Kossard S. Primary cutaneous diffuse leiomyosarcoma with desmoplasia. Australas J Dermatol 2006; 47: 291–295.
44. Karroum J, Zappi E, Cockerell C. Sclerotic primary cutaneous leiomyosarcoma. Am J Dermatopathol 1995; 17: 292–296.
45. Diaz-Cascajo C, Borghi S, Weyers W. Desmoplastic leiomyosarcoma of the skin. Am J Dermatopathol 2000; 22:251–255.
46. Berzal-Cantalejo F, Sabater-Marco V, Perez-Valles A. et al. Desmoplastic cutaneous leiomyosarcoma: case report and review of the literature. J Cutan Pathol 2006; 33(Suppl 2): 29–31.
47. Fernandez-Flores A. Cutaneous leiomyomas and leiomyosarcomas: an immunohistochemical study with p53. Rom J Morphol Embryol 2010; 51: 295–298.
48. Hall B, Grossmann A, Webber N. et al. Atypical intradermal smooth muscle neoplasms (formerly cutaneous leiomyosarcomas): case series, immunohistochemical profile and review of the literature. Appl Immunohistochem Mol Morphol 2013; 21: 132–138.
49. Carvalho J, Thomas D, Lucas D. Cluster analysis of immunohistochemical markers in leiomyosarcoma delineates specific anatomic and gender subgroups. Cancer 2009; 115: 4186–4195
50. Trojani M, Contesso G, Coindre J, et al. Soft-tissue sarcomas of adults; study of pathological prognostic variables and definition of a histopathological grading system. Int J Cancer 1984; 33: 37–42.
51. Amin M, Edge S, Greene F. et al. AJCC Cancer Staging Manual, 8th edn. Cham, Switzterland: Springer International Publishing, 2017.
52. Jensen M, Jensen O, Michalski W. et al. Intradermal and subcutaneous leiomyosarcoma: a clinicopathological and immunohistochemical study of 41 cases. J Cutan Pathol. 1996; 23:458–463.
53. Glazer E, Prieto-Granada C, Zager J. Current approaches to cutaneous sarcomas: dermatofibrosarcoma protuberans and cutaneous leiomyosarcoma. Curr Probl Cancer 2015; 39: 248– 257
54. Feigenbaum L, Skinner D, Golda N. Atypical cutaneous leiomyosarcoma with skip-lesion behavior. Dermatol Surg 2013;39: 660–662
55. Vujevich J, Goldberg L, Kimyai-Asadi A. et al. Recurrent nodule on the nasal columella: a good reason to re-biopsy. Int J Dermatol 2008; 47: 728–731.
56. Fauth C, Bruecks A, Temple W. et al. Superficial leiomyosarcoma: a clinicopathologic review and update. J Cutan Pathol 2010; 37: 269–276
57. Huether M, Zitelli J, Brodland D. Mohs micrographic surgery for the treatment of spindle cell tumors of the skin. J Am Acad Derm atol 2001; 44: 656–659.
58. Wollina U, Koch A, Hansel G. et al. A 10-year analysis of cutaneous mesenchymal tumors (sarcomas and related entities) in a skin cancer center. Int J Dermatol 2013; 52: 1189–1197.
59. Humphreys T, Finkelstein D, Lee J. Superficial leiomyosarcoma treated with Mohs micrographic surgery. Dermatolo Surg 2004; 30: 108–112.
60. Kazlouskaya V, Lai Y, Khachemoune A. Leiomyosarcoma of the skin: review of the literature with an emphasis on prognosis and management. International Journal of Dermatology. Feb. 2020;59(2):165-172.
61. Ghareeb E, Dulmage B, Vargo J. et al. Underutilization of mohs micrographic surgery for less common cutaneous malignancies in the United States. Dermatol Surg 2016 ; 42 : 653–662.
62. Svarvar C, Böhling T, Berlin Ö. et al. Clinical course of nonvisceral soft tissue leiomyosarcoma in 225 patients from the Scandinavian sarcoma group. Cancer. 2007;109:282–291
63. Wascher R, Lee M. Recurrent cutaneous leiomyosarcoma. Cancer 1992; 70; 490–492.
64. Jegasothy B, Gilgor R, Hull D. Leiomyosarcoma of the skin and subcutaneous tissue. Arch Dermatol 1981;117:478–81.
65. Porter C, Januszkiewicz J. Cutaneous leiomyosarcoma. Plast Reconstr Surg 2002;109:964–7.
66. Hess K, Hanke C, Estes N. et al. Chemosurgical reports: myxoid dermatofibrosarcoma protuberans. J Dermatol Surg Oncol 1985
67. Hashimoto H, Daimaru Y, Tsuneyoshi M. et al. Leiomyosarcoma of the external soft tissues. A clinicopathologic, immunohistochemical, and electron microscopic study. Cancer 1986; 57: 2077–2088.
68. Bresler S, Gosnell H, Ko J. Subcutaneous Leiomyosarcoma An Aggressive Malignancy Portending a Significant Risk of Metastasis and Death. Am J Surg Pathol, Volume 47, Number 12, December 2023
69. Wong G, Webb A, Gyorki D. et al (2020) Cutaneous leiomyosarcoma: dermal and subcutaneous. Australas J Dermatol 61:243–249
70. Ferrari A, Bisogno G, Casanova M. et al. Childhood leiomyosarcoma: a report from the Soft Tissue Sarcoma Italian Cooperative Group. Ann Oncol 2001 ; 12 : 1163-8
71. Tetzlaff M, Nosek C, Kovarik C. Epstein-Barr virus associated leiomyosarcoma with cutaneous involvement in an African child with human immunodeficiency virus: a case report and review of the literature. J Cutan Pathol 2011; 38: 731–739.
72. McClain K, Leach C, Jenson H. et al. Association of Epstein-Barr virus with leiomyosarcomas in children with AIDS. N Engl J Med 1995; 332: 12–18.
73. Derre J, Lagace R, Nicolas A. et al. Leiomyosarcomas and most malignant fibrous histiocytomas share very similar comparative genomic hybridization imbalances: an analysis of a series of 27 leiomyosarcomas. Lab Invest 2001; 81: 211–215.
74. Wang W, Bones-Valentin R, Prieto V. et al. Sarcoma metastases to the skin: a clinicopathologic study of 65 patients. Cancer. 2012;118:2900–2904.
75. Weiler L, Poulalhon N, Slama A. et al. Isolated cutaneous leio¬myosarcoma revealing a novel germline mutation of the fumarate hydratase gene. Br J Dermatol 2016 ; 175 :1104–6
76. Konomoto T, Fukuda T, Hayashi K. et al. Leiomyosarcoma in soft tissue: examination of p53 status and cell proliferating factors in different locations. Hum Pathol 1998; 29: 74–81.
77. Kawaguchi K, Oda Y, Saito T. et al. Mechanisms of inactivation of the p16INK4a gene in leiomyosarcoma of soft tissue: decreased p16 expression correlates with promoter methylation and poor prognosis. J Pathol 2003; 201: 487–495.
78. Sabater-Marco V, Ferrando-Roca F, Morera-Faet A. et al. Primary cutaneous leiomyosarcoma arising in a patient with li-fraumeni syndrome: a neoplasm with unusual histopathologic features and loss of heterozygosity at TP53 gene. Am J Dermatopathol 2018; 40: 225–227.
2. Stout A, Hill W. Leiomyosarcoma of the superficial soft tissue. Cancer 1964; 11: 844.
3. Liao W, Wang Y, Ma H. Cutaneous leiomyosarcoma: the clinical experience of Taipei veterans general hospital revisited. Ann Plast Surg 2017; 78(3 Suppl 2): S47–S51.
4. Massi D, Franchi A, Alos L, et al. Primary cutaneous leiomyosarcoma: clinicopathological analysis of 36 cases. Histopathology. 2010;56:251–262.
5. Kraft S, Fletcher C. Atypical intradermal smooth muscle neoplasms: clinicopathologic analysis of 84 cases and a reappraisal of cutaneous “leiomyosarcoma”. Am J Surg Pathol. 2011;35:599–607
6.Fields J, Helwig E. Leiomyosarcoma of the skin and subcutaneous tissue. Cancer. 1981;47:156–169.
7. Snowden R, Osborn F, Wong F. et al. Superficial leiomyosarcoma of the head and neck: case report and review of the literature. Ear Nose Throat J. 2001; 80; 449–453
8. Kaddu S, Beham A, Cerroni L. et al. Cutaneous leiomyosarcoma. Am. J. Surg. Pathol. 1997; 21; 979–987
9. Annest N, Grekin S, Stone M. et al. Cutaneous leiomyosarcoma: a tumor of the head and neck. Dermatol. Surg. 2007; 33; 628–633.
10. González-Sixto B, De la Torre C, Pardavila R. et al. Leiomyosarcoma arising from scrofuloderma scar. Clin Exp Dermatol. 2008;33:776–778
11. West C, Morritt A, Pedelty L. et al. Cutaneous leiomyosarcoma arising in a tattoo—‘a tumour with no humour’. J Plast Reconstr Aesthet Surg. 2009;62: e79
12. González-Vela M, Val-Bernal J, Rubio S. et al. Cutaneous leiomyosarcoma developing on a pacemaker pocket. Dermatol Surg. 2009 ;35 :863–867.
13. Pol R, Dannenberg H, Robertus J. et al. Cutaneous leiomyosarcoma arising in a smallpox scar. World J Surg Oncol. 2012;10:148.
14. Weiss S, Goldblum J. Enzinger and Weiss's Soft Tissue Tumors. 6th ed. Saunders; 2013
15.Holst V, Junkins-Hopkins J, Elenitsas R. Cutaneous smooth muscle neoplasms: clinical features, histologic findings, and treatment options. J Am Acad Dermatol. 2002;46:477–490.
16. Pijpe J, Broers G, Plaat B. et al. The relation between histological, tumor biological and clinical parameters in deep and superficial leiomyosarcoma and leiomyoma. Sarcoma. 2002;6:105–110.
17. Fons M, Bachhuber T, Plaza J. Cutaneous leiomyosarcoma originating in a symplastic pilar leiomyoma: a rare occurrence and potential diagnostic pitfall. J Cutan Pathol. 2011;38:49–53.
18. Winchester D, Hocker T, Brewer J. et al. Leiomyosarcoma of the skin: clinical, histopathologic, and prognostic factors that influence outcomes. J Am Acad Dermatol. 2014;71:919–925
19. Blaise G, Nikkels A. Childhood cutaneous leiomyosarcoma. Pediatr Dermatol. 2009; 26:477–479.
20. Bellezza G, Sidoni A, Cavaliere A. et al. Primary cutaneous leiomyosarcoma: a clinicopathological and immunohistochemical study of 7 cases. Int J Surg Pathol. 2004;12:39–44.
21. Bernstein S, Roenigk R. Leiomyosarcoma of the skin. Treatment of 34 cases. Dermatol Surg. 1996; 22:631–635.
22. Yanguas I, Goday J, González-Güemes M. et al. Cutaneous leiomyosarcoma in a child. Pediatr Dermatol. 1997; 14:281–283.
23. Miyajima K, Oda Y, Oshiro Y. et al. Clinicopathological prognostic factors in soft tissue leiomyosarcoma: a multivariate analysis. Histopathology. 2002;40: 353–359.
24. Oliver G, Reiman H, Gonchoroff N. et al. Cutaneous and subcutaneous leiomyosarcoma: a clinicopathological review of 14 cases with reference to antidesmin staining and nuclear DNA patterns studied by flow cytometry. Br J Dermatol. 1991;124:252–257
25. Christopher J, Porter M, Januszkiewicz J. Cutaneous leiomyosarcoma. Plast Reconstr Surg. 2002 ;109 :964–967
26. Iacobucci J, Stevenson T, Swanson N, et al. Cutaneous leiomyosarcoma. Ann Plast Surg. 1987;19:552–554.
27. Lin J, Tsai R. Subcutaneous leiomyosarcoma on the face. Dermatol Surg. 1999;25:489–491.
28. Tsutsumida A, Yoshida T, Yamamoto Y. Management of superficial leiomyosarcoma: a retrospective study of 10 cases. Plast Reconstr Surg. 2005; 116:8–12.
29. Starling J, Coldiron BM. Mohs micrographic surgery for the treatment of cutaneous leiomyosarcoma. J Am Acad Dermatol. 2011;64:1119–1122.
30. Deneve J, Messina J, Bui M, et al. Cutaneous leiomyosarcoma: treatment and outcomes with a standardized margin of resection. Cancer Control. 2013; 20:307–312.
31. Llombart B, Serra-Guillén C, Requena C. et al. Leiomyosarcoma and pleomorphic dermal sarcoma: guidelines for diagnosis and treatment. Actas Dermosifiliogr. 2019;110:4 – 11
32. Kohlmeyer J, Steimle-Grauer S, Hein R. Cutaneous sarcomas. J Dtsch Dermatol Ges. 2017;15:630 – 48
33. John T, Portenier D, Auster B. et al. Leiomyosarcoma of the scrotum – a case report and review of the literature. Urology 2006;67(2):424e13–15.
34. Torres T, Oliveira A, Sanches M. et al. Superficial cutaneous leiomyosarcoma of the face: report of three cases. J Dermatol. 2011;38:373– 376.
35. Taylor M, Thomas S, Ituarte B. et al. Sex disparities in leiomyosarcoma of the skin: females experience worse disease‑specific survival. Archives of Dermatological Research (2024) 316:469
36. Zaballos P, Del Pozo L, Argenziano G. et al. Dermoscopy of cutaneous smooth muscle neoplasms: a morphological study of 136 cases. J Eur Acad Dermatol Venereol 2019; 33: 693–699.
37. Dahl I, Angervall L. Cutaneous and subcutaneous leiomyosarcoma: a clinicopathologic study of 47 patients. Pathol Eur. 1974;9: 307–315.
38. Davidson L, Frost M, Hanke W. et al. Primary leiomyosarcoma of the skin: case report and review of the literature. J Am Acad Dermatol 1989;21:1156–60.
39. Aneiros-Fernandez J, Antonio Retamero J, Husein-Elahmed H. et al. Primary cutaneous and subcutaneous leiomyosarcomas: review of their evolution and prognostic factors. Eur J Dermatol 2016; 26(1): 9-12 doi:10.1684/ejd.2015.2681
40. Weedon D, Williamson R, Patterson J. Smooth and skeletal muscle tumours. World Health Organization classification of tumours. Pathology & genetics. Skin tumours. Lyon: IARC Press, 2006; 250–253
41. Idriss M, Kazlouskaya V, Malhotra S. et al. Phosphohistone- H3 and Ki-67 immunostaining in cutaneous pilar leiomyoma and leiomyosarcoma (atypical intradermal smooth muscle neoplasm). J Cutan Pathol 2013 ; 40 : 557–563
42. Atzori L, Pilloni L, Zanniello R. et al. Clear-cell variant of superficial cutaneous leiomyosarcoma associated with RB1 mutation: Clinical, dermoscopic, and histopathological characteristics. J Cutan Pathol. 2020;47:571–575.
43. Choy C, Cooper A, Kossard S. Primary cutaneous diffuse leiomyosarcoma with desmoplasia. Australas J Dermatol 2006; 47: 291–295.
44. Karroum J, Zappi E, Cockerell C. Sclerotic primary cutaneous leiomyosarcoma. Am J Dermatopathol 1995; 17: 292–296.
45. Diaz-Cascajo C, Borghi S, Weyers W. Desmoplastic leiomyosarcoma of the skin. Am J Dermatopathol 2000; 22:251–255.
46. Berzal-Cantalejo F, Sabater-Marco V, Perez-Valles A. et al. Desmoplastic cutaneous leiomyosarcoma: case report and review of the literature. J Cutan Pathol 2006; 33(Suppl 2): 29–31.
47. Fernandez-Flores A. Cutaneous leiomyomas and leiomyosarcomas: an immunohistochemical study with p53. Rom J Morphol Embryol 2010; 51: 295–298.
48. Hall B, Grossmann A, Webber N. et al. Atypical intradermal smooth muscle neoplasms (formerly cutaneous leiomyosarcomas): case series, immunohistochemical profile and review of the literature. Appl Immunohistochem Mol Morphol 2013; 21: 132–138.
49. Carvalho J, Thomas D, Lucas D. Cluster analysis of immunohistochemical markers in leiomyosarcoma delineates specific anatomic and gender subgroups. Cancer 2009; 115: 4186–4195
50. Trojani M, Contesso G, Coindre J, et al. Soft-tissue sarcomas of adults; study of pathological prognostic variables and definition of a histopathological grading system. Int J Cancer 1984; 33: 37–42.
51. Amin M, Edge S, Greene F. et al. AJCC Cancer Staging Manual, 8th edn. Cham, Switzterland: Springer International Publishing, 2017.
52. Jensen M, Jensen O, Michalski W. et al. Intradermal and subcutaneous leiomyosarcoma: a clinicopathological and immunohistochemical study of 41 cases. J Cutan Pathol. 1996; 23:458–463.
53. Glazer E, Prieto-Granada C, Zager J. Current approaches to cutaneous sarcomas: dermatofibrosarcoma protuberans and cutaneous leiomyosarcoma. Curr Probl Cancer 2015; 39: 248– 257
54. Feigenbaum L, Skinner D, Golda N. Atypical cutaneous leiomyosarcoma with skip-lesion behavior. Dermatol Surg 2013;39: 660–662
55. Vujevich J, Goldberg L, Kimyai-Asadi A. et al. Recurrent nodule on the nasal columella: a good reason to re-biopsy. Int J Dermatol 2008; 47: 728–731.
56. Fauth C, Bruecks A, Temple W. et al. Superficial leiomyosarcoma: a clinicopathologic review and update. J Cutan Pathol 2010; 37: 269–276
57. Huether M, Zitelli J, Brodland D. Mohs micrographic surgery for the treatment of spindle cell tumors of the skin. J Am Acad Derm atol 2001; 44: 656–659.
58. Wollina U, Koch A, Hansel G. et al. A 10-year analysis of cutaneous mesenchymal tumors (sarcomas and related entities) in a skin cancer center. Int J Dermatol 2013; 52: 1189–1197.
59. Humphreys T, Finkelstein D, Lee J. Superficial leiomyosarcoma treated with Mohs micrographic surgery. Dermatolo Surg 2004; 30: 108–112.
60. Kazlouskaya V, Lai Y, Khachemoune A. Leiomyosarcoma of the skin: review of the literature with an emphasis on prognosis and management. International Journal of Dermatology. Feb. 2020;59(2):165-172.
61. Ghareeb E, Dulmage B, Vargo J. et al. Underutilization of mohs micrographic surgery for less common cutaneous malignancies in the United States. Dermatol Surg 2016 ; 42 : 653–662.
62. Svarvar C, Böhling T, Berlin Ö. et al. Clinical course of nonvisceral soft tissue leiomyosarcoma in 225 patients from the Scandinavian sarcoma group. Cancer. 2007;109:282–291
63. Wascher R, Lee M. Recurrent cutaneous leiomyosarcoma. Cancer 1992; 70; 490–492.
64. Jegasothy B, Gilgor R, Hull D. Leiomyosarcoma of the skin and subcutaneous tissue. Arch Dermatol 1981;117:478–81.
65. Porter C, Januszkiewicz J. Cutaneous leiomyosarcoma. Plast Reconstr Surg 2002;109:964–7.
66. Hess K, Hanke C, Estes N. et al. Chemosurgical reports: myxoid dermatofibrosarcoma protuberans. J Dermatol Surg Oncol 1985
67. Hashimoto H, Daimaru Y, Tsuneyoshi M. et al. Leiomyosarcoma of the external soft tissues. A clinicopathologic, immunohistochemical, and electron microscopic study. Cancer 1986; 57: 2077–2088.
68. Bresler S, Gosnell H, Ko J. Subcutaneous Leiomyosarcoma An Aggressive Malignancy Portending a Significant Risk of Metastasis and Death. Am J Surg Pathol, Volume 47, Number 12, December 2023
69. Wong G, Webb A, Gyorki D. et al (2020) Cutaneous leiomyosarcoma: dermal and subcutaneous. Australas J Dermatol 61:243–249
70. Ferrari A, Bisogno G, Casanova M. et al. Childhood leiomyosarcoma: a report from the Soft Tissue Sarcoma Italian Cooperative Group. Ann Oncol 2001 ; 12 : 1163-8
71. Tetzlaff M, Nosek C, Kovarik C. Epstein-Barr virus associated leiomyosarcoma with cutaneous involvement in an African child with human immunodeficiency virus: a case report and review of the literature. J Cutan Pathol 2011; 38: 731–739.
72. McClain K, Leach C, Jenson H. et al. Association of Epstein-Barr virus with leiomyosarcomas in children with AIDS. N Engl J Med 1995; 332: 12–18.
73. Derre J, Lagace R, Nicolas A. et al. Leiomyosarcomas and most malignant fibrous histiocytomas share very similar comparative genomic hybridization imbalances: an analysis of a series of 27 leiomyosarcomas. Lab Invest 2001; 81: 211–215.
74. Wang W, Bones-Valentin R, Prieto V. et al. Sarcoma metastases to the skin: a clinicopathologic study of 65 patients. Cancer. 2012;118:2900–2904.
75. Weiler L, Poulalhon N, Slama A. et al. Isolated cutaneous leio¬myosarcoma revealing a novel germline mutation of the fumarate hydratase gene. Br J Dermatol 2016 ; 175 :1104–6
76. Konomoto T, Fukuda T, Hayashi K. et al. Leiomyosarcoma in soft tissue: examination of p53 status and cell proliferating factors in different locations. Hum Pathol 1998; 29: 74–81.
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