Cutaneous Leiomyosarcoma: Clinical Presentation, Histological Diagnosis, and Surgical Management

Abstract

Introduction: Cutaneous leiomyosarcoma is a rare malignant tumor derived from smooth muscle cells in the dermis or subcutaneous tissue. Due to its rarity and nonspecific clinical presentation, accurate diagnosis is often delayed and requires histopathological and immunohistochemical confirmation. Methods: We report two cases of primary cutaneous leiomyosarcoma in middle-aged male patients. The first case involved a 59-year-old man with a slowly growing dorsal nodule over five years. The second case was a 57-year-old man with a painful nodular lesion on the right leg evolving over nine months. Both cases underwent clinical examination, imaging, histopathology, and immunohistochemistry for diagnosis. Surgical excision was performed in both patients. Results: Histological analysis in both cases showed spindle-cell tumors with immunopositivity for smooth muscle actin and H-caldesmon.. Margins were initially involved in both cases, requiring re-excision. The second patient also underwent periosteal resection and reconstruction with a keystone flap, followed by adjuvant radiotherapy. No local recurrence or metastasis was observed at three-year follow-up for either patient. Discussion: These cases highlight the diagnostic difficulty of CLM and the critical role of immunohistochemistry in its confirmation. Complete surgical excision with clear margins remains the gold standard. Adjuvant radiotherapy may be considered in cases with deep invasion or involved margins. Long-term follow-up is essential due to the risk of recurrence and metastasis, which can occur years after initial treatment. Conclusion: Cutaneous and subcutaneous leiomyosarcomas pose challenges in terms of both diagnosis and therapeutic management. The risk of local recurrence and metastasis varies according to subtype, highlighting the importance of maintaining healthy excision margins, and the need for prolonged clinical and paraclinical follow-up.