title: Leiomyosarcoma of the skin: clinical, histopathologic, and prognostic factors that influence outcomes.
abstract: BACKGROUND
  Superficial leiomyosarcoma (LMS) is a rare tumor with important clinical, pathologic, and treatment features. Previous LMS studies have included few patients, included minimal follow-up, and typically combined the superficial and subfascial (deep) forms.
  
  
  OBJECTIVE
  We sought to characterize clinical features, effectiveness of treatment approaches, and long-term outcomes for LMS stratified by depth of invasion.
  
  
  METHODS
  In all, 71 cases of primary superficial LMS, 48 dermal and 23 subcutaneous (mean follow-up of 8 years), were examined and clinical, histopathologic, and treatment factors reported.
  
  
  RESULTS
  Tumor size and subcutaneous classification correlated with greater likelihood of metastasis and death at 5 years. When superficial LMS metastasizes, other skin sites are the most common distant location. Treatment with wide local excision with minimum 1-cm margins showed statistically lower rates of recurrences and metastasis compared with excision with narrow surgical margins. Fourteen cases of Mohs micrographic surgery had no recurrences or metastases. Five cases of dermal LMS metastasized, 2 of which resulted in death.
  
  
  CONCLUSIONS
  This study is a retrospective review of a relatively small number of patients.
  
  
  CONCLUSIONS
  LMS can metastasize and warrants surgical intervention and long-term follow-up. Wide local excision, and Mohs micrographic surgery in particular, appear to provide the best management approach for definitive treatment.
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Winchester
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Hocker
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Jerry D
authors.initials: JD
authors.lastname: Brewer
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Christian L
authors.initials: CL
authors.lastname: Baum
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Philip C
authors.initials: PC
authors.lastname: Hochwalt
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Arpey
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Clark C
authors.initials: CC
authors.lastname: Otley
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, Minnesota. Electronic address: Roenigk.Randall@mayo.edu.
authors.forename: Randall K
authors.initials: RK
authors.lastname: Roenigk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007890:Leiomyosarcoma / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D018365:Neoplasm, Residual; D011379:Prognosis; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery*; D015996:Survival Rate; D047368:Tumor Burden; D055815:Young Adult
keywords: Mohs micrographic surgery; atypical smooth muscle neoplasm; cutaneous oncology; dermatologic surgery; leiomyosarcoma; skin metastasis; tumor differentiation; wide local excision