Cutaneous leiomyosarcoma (CL). CL
is a rare malignant tumor representing about 10% of all
soft tissue sarcomas. It is the third most common cutaneous sarcoma
after dermatofibrosarcoma protuberans and atypical fibroxanthoma.
The usual age of occurrence is between 50 to 70 years. A
distinction has been made between cutaneous and subcutaneous
leiomyosarcoma, with the former predominantly occurring in the
erector pili muscles surrounding sweat glands and the latter in the
smooth muscle cells of vessel walls. The lesions of CL may be
painful and commonly are reddish to bluish plaques with an
irregular nodular surface measuring between 2 and 5 cm, as
illustrated. In contrast, the subcutaneous form commonly occurs as
painless subcutaneous nodules or diffuse swellings covered by
freely moveable, nondiscolored skin. Multifocal disease is rare,
and in such cases, deep or visceral leiomyosarcoma must be ruled
out . The anterior surfaces of the lower
limbs, where hair follicles are abundant, are most commonly
affected, although atypical localizations have also been described
involving the penis  and external auditory
canal . Trauma and radiotherapy are the most
commonly reported predisposing factors. The first line of treatment
for both cutaneous and subcutaneous leiomyosarcoma is surgical
excision with a 3‐ to 5‐cm margin of healthy skin
removed around the tumor ,. Radiotherapy may play a role when it is not possible
to obtain the recommended margin of healthy skin. Preoperative
neoadjuvant chemotherapy using a combination of adriblastin,
ifosfamide, and dacarbazine has been used in cases of voluminous
forms of the tumor. In addition, regional chemotherapy in the form
of limb isolation perfusion has provided good results for sarcoma
of the limbs . Prognostic factors for CL
predominantly depend on histologic location, although clinical
factors such as tumor diameter  are also
important. CL has a favorable outcome with a low incidence of local
recurrence and almost no distal metastasis ,
whereas the subcutaneous variant carries a higher risk of visceral
metastasis, particularly to the lung and liver .
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