Primary cutaneous and subcutaneous leiomyosarcomas: evolution and prognostic factors

Area of Science:

• Oncology
• Dermatology
• Surgical Pathology

Background:

• Cutaneous and subcutaneous leiomyosarcomas (LMS) are infrequent malignant neoplasms.
• Understanding their distinct prognostic factors and behavior is crucial for patient management.

Purpose of the Study:

• To review and compare recurrence, metastasis, and mortality rates of cutaneous and subcutaneous LMS.
• To identify prognostic factors and recommend appropriate follow-up periods for these rare tumors.

Main Methods:

• A comprehensive review of the MEDLINE database was conducted.
• Data from 112 subcutaneous LMS and 313 cutaneous LMS cases were analyzed.
• Recurrence, metastasis, mortality rates, and prognostic factors were assessed.

Main Results:

• Subcutaneous LMS exhibited higher rates of recurrence (36.63%), metastasis (43.23%), and mortality (37.82%) compared to cutaneous LMS (24.40%, 4.22%, 3.33%, respectively).
• Location, size, and histologic grade are significant prognostic factors for superficial LMS.
• Complete excision with at least a 1 cm surgical margin is recommended to prevent recurrence.

Conclusions:

• Cutaneous and subcutaneous LMS, despite similar morphology, demonstrate significantly different clinical behaviors.
• Subcutaneous LMS present a greater risk of adverse outcomes, warranting prolonged surveillance.
• A minimum five-year follow-up is recommended for both types of LMS.