title: A peculiar case of large primary cutaneous Ewing's sarcoma of the foot: Case report and review of the literature.
abstract: BACKGROUND
  Primary cutaneous extraskeletal Ewing's sarcomas (ESs) are extremely rare tumors, limited to the skin and generally appear as a single small lesion, circumscribed mid-to-deep dermis or involving subcutis. Due to their rarity and morphological similarity to other cutaneous tumors, ESs are subject to being clinically and pathologically subdiagnosed.
  
  
  METHODS
  A 37-year-old man presented a large rapidly growing mass of the first toe measuring 9.5×8cm with no radiological evidence of bone involvement. The patient underwent wide surgical tumor resection; histological, immunohistochemical and molecular evaluation confirmed the diagnosis of ESs. Postoperative examinations revealed no metastasis and after 11 months follow-up no recurrences were detected.
  
  
  CONCLUSIONS
  Current literature reports only a few isolated cases or small series. ESs are generally described as small masses with a favorable clinical behavior. Despite lower extremity is a relatively frequent site, only rare and small ESs of the foot have been reported. To our knowledge the present case is the largest ES of the foot. Despite its large size, the patient did not report any metastases confirming the hypothesis of treating superficial ES with surgery alone, thus avoiding adjuvant radiotherapy and/or chemotherapy and their related side-effects.
  
  
  CONCLUSIONS
  ESs still remain exceedingly rare tumors and they could not be taken in consideration into differential diagnosis. This case represents a peculiar example of large ES in an uncommon site as the foot successfully treated with surgery alone, and may serve as an alert for those physicians who approach such rapidly growing superficial lesions.
authors: Department of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, Regional Hospital, Ancona, Italy.
authors: Luca
authors: L
authors: Grassetti
authors: Department of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, Regional Hospital, Ancona, Italy. Electronic address: torresetti.matteo@gmail.com.
authors: Matteo
authors: M
authors: Torresetti
authors: Department of Biomedical Sciences and Public Health, Division of Pathological Anatomy, Marche Polytechnic University Medical School, Regional Hospital, Ancona, Italy.
authors: Donatella
authors: D
authors: Brancorsini
authors: Department of Biomedical Sciences and Public Health, Division of Pathological Anatomy, Marche Polytechnic University Medical School, Regional Hospital, Ancona, Italy.
authors: Corrado
authors: C
authors: Rubini
authors: Plastic, Reconstructive and Aesthetic Surgery Unit, Villa Salaria Clinic, Rome, Italy.
authors: Davide
authors: D
authors: Lazzeri
authors: Department of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, Regional Hospital, Ancona, Italy.
authors: Giovanni
authors: G
authors: Di Benedetto
keywords: Cutaneous Ewing sarcoma; Extraskeletal Ewing sarcoma; Foot sarcoma