Superficial leiomyosarcoma treated with Mohs micrographic surgery.

Background: Leiomyosarcoma (LMS) is a rare cutaneous malignancy with an infiltrative growth pattern and high risk of local recurrence (30-45%) with conventional wide excision. Mohs micrographic surgery (MMS) may offer an improved cure.

Objective: To illustrate by case reports the spectrum of clinical presentation of this rare neoplasm and management with MMS.

Methods: The outcomes of three cases of LMS treated by Mohs micrographic are described and compared with other cases in the medical literature.

Results: Three cases of LMS were excised using MMS. Two cutaneous tumors located on the trunk and arm were easily removed and have not recurred. The third tumor on the leg of an immunosuppressed patient demonstrated deep soft-tissue invasion that developed subsequent cutaneous metastases but no recurrence adjacent to the primary site. The patient remains disease free at 36 months after amputation below the knee. A total of 15 cases of LMS treated by MMS are reported in the literature, including these cases, with an aggregate recurrence rate of 13%.

Conclusions: The overall cure rate of leiomyosarcoma treated by MMS is 87%, which compares favorably to wide excision and offers the advantage of tissue sparing. Immunosuppression may promote aggressive tumor behavior. Deeply invasive tumors may result in cutaneous or distant metastases regardless of the method of excision.