The most common sarcoma of the skin is a pleomorphic sarcoma. It can also be called an undifferentiated pleomorphic sarcoma. The most common skin sarcoma is a malignant fibrous histiocytoma (MFH). These lesions can be confused with an atypical fibroxanthoma (AFX). AFX tends to appear as a dermal nodule without significant skin change on the surface, while sarcoma or MFH presents as an ulcerating nodule due to its aggressive growth. Skin sarcomas like all sarcomas are highly aggressive with ability to spread through angioinvasion, perineural invasion, and lymphatic spread. These lesions also have a tendency of exhibiting intradermal skip areas with dermal metastases. Treatment of skin sarcomas involve wide local resection, followed by radiation. Lymph node evaluation with either sentinel lymph node biopsies or lymphadenectomies can aid in staging the cancer.
HISTORY 89 year old woman presented in 1/2017 with a lesion on scalp. Biopsy from 12/30/16 first showed squamous cell carcinoma but a second opinion revealed atypical fibroxanthoma. Mohs and reconstruction performed on 1/23/2017, with the core specimen sent for additional analysis which revealed undifferentiated pleomorphic sarcoma. DISCUSSION This 89-year-old woman presented with an exophytic…Read More
HISTORY 93-year-old man presents with an incidentally discovered left neck mass during evaluation of a left ear SCC. Initial biopsy on 9-5-17 showed atypical fibroxanthoma. Excision of the left neck lesion with 5 mm margins on 9-26-17 revealed malignant spindle and epithelioid cell neoplasm consistent with pleomorphic dermal sarcoma. Deep and peripheral margins were…Read More
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