Sarcomas of the skin in the elderly

Malignant mesenchymal neoplasms of skin and soft tissues are characterized by an extreme clinicopathologic heterogeneity. Although all sarcomas of deep soft tissues may also arise in superficial locations, there are important clinicopathologic differences. Lipogenic sarcomas represent the most frequent type of sarcomas in deep soft tissues, but purely dermal liposarcomas are exceedingly rare. Vascular and fibroblastic or myofibroblastic sarcomas, however, are much more frequent in dermal location. In contrast with most deep-seated sarcomas, morphologic grading of dermal sarcomas has only a limited importance because most types of dermal sarcoma have a rather favorable clinical prognosis. Important exceptions to this rule are epithelioid sarcoma and cutaneous angiosarcoma, which are aggressive sarcomas with an increased rate of distant metastases and tumor-associated death. Dermal sarcomas arising in elderly patients show some important differences in their incidence and prognosis. Whereas cutaneous angiosarcoma, myxofibrosarcoma, undifferentiated pleomorphic sarcoma of the skin showing morphologic similarities to atypical fibroxanthoma, and cutaneous leiomyosarcoma arise predominantly in elderly patients, dermatofibrosarcoma protuberans, epithelioid sarcoma, and superficially located clear cell sarcoma are seen more often in younger patients.