Santos EE, Sarma DP (2007). Cutaneous leiomyosarcoma of the face. The Internet J Dermatol 5(1). Indexed by Google Scholar.

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Cutaneous Leiomyosarcoma of the Face

E Santos, D Sarma



E Santos, D Sarma. Cutaneous Leiomyosarcoma of the Face. The Internet Journal of Dermatology. 2006 Volume 5 Number 1.


We are reporting a case of cutaneous leiomyosarcoma occurring on the face of a 98-year-old woman with a brief review of the literature.




A 98-year-old woman presented with a painful, nodular skin lesion localized to her left cheek. The skin surface was  raised and dark brown to black. She reported no other associated symptoms and denied having other similar skin lesions. Her past medical history was otherwise unremarkable.

On microscopic examination of the shave biopsy, the skin lesion showed a diffuse nodular proliferation of spindle cells with moderate cellular pleomorphism and an increased mitotic rate of up to 10 mitoses per high power field. The overlying epidermis was unremarkable (Figures 1 &  2).

Figure 1: Cutaneous leiomyosarcoma, low magnification: Dermal proliferation of interlacing fascicles of spindle  cells.


Figure 2: Cutaneous leiomyosarcoma, high  magnification.


Multiple immunohistochemical stains were performed that showed positive tumor cell staining for vimentin and smooth muscle actin (Figure 3), and negative staining for S-100, CD34, and Melan A. The lesion was interpreted as a leiomyosarcoma. A complete excision was  recommended.

Figure 3: Cutaneous leiomyosarcoma, Focal positive staining with SMA (smooth muscle actin).



Primary cutaneous leiomyosarcomas are rare neoplasms, either located in the dermis or subcutaneous tissue. More than 100 cases of dermal leiomyosarcomas have been reported [1], most occurring in patients usually around the sixth decade of life. Our patient probably represents one  of the oldest patients with this lesion. Most of the lesions are located in the extremities. We could only uncover one report of dermal leiomyosarcoma occurring in the face [2].

Although the lesion was localized to the dermis in this case, skin leiomyosarcomas can also appear within the subcutis. Surgical excision is the treatment of choice. High rates of local recurrence for both cutaneous and subcutaneous lesions ranging from 50% to 70% have been previously  reported.

Histological factors that have been reported to predict recurrence rate include size of lesion, increased mitotic count, and tumor extension to the subcutis.


Deba P. Sarma, MD Department of Pathology Creighton University Medical Center Omaha, NE 68131 Tel: 402-449-4951 E-mail:


  1. Weedon, D. Skin Pathology. 2nd ed. Edinburgh: Churchill Livingston, 2002.
  2. Orellana-Diaz, O, and E Hernandez-Perez. “Leiomyoma Cuis and Leiomyosarcoma: a 10-Year Study and a Short Review.” Journal of Dermatology and Surgical Oncology 9 (1983): 283-287.

Author Information

Eric E. Santos, M.D.

Senior Resident, Department of Pathology, Creighton University Medical  School

Deba P. Sarma, M.D.

Professor, Department of Pathology, Creighton University Medical  School