Comment on: "Clinicopathologic and molecular analyses of cutaneous leiomyosarcoma: A retrospective, multicenter study of 79 cases".

To the Editor: We read with great interest Planet et al's1Planet C. Dalle S. Dereure O. et al.Clinicopathologic and molecular analyses of cutaneous leiomyosarcoma: a retrospective, multicenter study of 79 cases.J Am Acad Dermatol. 2023; 88: 215-216Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar study characterizing the clinicopathologic features and prognostic factors of cutaneous leiomyosarcoma. In this retrospective, multicenter study of 79 cutaneous leiomyosarcomas (defined by their criteria as confined to the dermis or involving the subcutis), the authors report recurrence in 15.2% of patients and regional or distant metastasis in 8.9% of patients included in their study. We agree with Planet et al's1Planet C. Dalle S. Dereure O. et al.Clinicopathologic and molecular analyses of cutaneous leiomyosarcoma: a retrospective, multicenter study of 79 cases.J Am Acad Dermatol. 2023; 88: 215-216Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar conclusion that cutaneous leiomyosarcoma overall portends a good prognosis. It is worth noting, however, that a distinction has been made in the pathology literature between atypical smooth muscle tumors arising in and confined to the dermis versus those extending into the subcutis.2Hall B.J. Grossmann A.H. Webber N.P. et al.Atypical intradermal smooth muscle neoplasms (formerly cutaneous leiomyosarcomas): case series, immunohistochemical profile and review of the literature.Appl Immunohistochem Mol Morphol. 2013; 21: 132-138Crossref PubMed Scopus (16) Google Scholar,3Kraft S. Fletcher C.D. Atypical intradermal smooth muscle neoplasms: clinicopathologic analysis of 84 cases and a reappraisal of cutaneous "leiomyosarcoma".Am J Surg Pathol. 2011; 35: 599-607Crossref PubMed Scopus (107) Google Scholar Kraft et al3Kraft S. Fletcher C.D. Atypical intradermal smooth muscle neoplasms: clinicopathologic analysis of 84 cases and a reappraisal of cutaneous "leiomyosarcoma".Am J Surg Pathol. 2011; 35: 599-607Crossref PubMed Scopus (107) Google Scholar demonstrated in a study of 84 patients that there were no metastases or deaths in dermally-based leiomyosarcomas that did not significantly involve the subcutis (mean follow-up 51 months). They proposed that “leiomyosarcomas” confined to the dermis no longer be regarded as a true sarcoma; they suggested an alternate terminology of “atypical intradermal smooth muscle neoplasm” given the benign biologic behavior of these lesions when confined to the dermis.3Kraft S. Fletcher C.D. Atypical intradermal smooth muscle neoplasms: clinicopathologic analysis of 84 cases and a reappraisal of cutaneous "leiomyosarcoma".Am J Surg Pathol. 2011; 35: 599-607Crossref PubMed Scopus (107) Google Scholar Hall et al2Hall B.J. Grossmann A.H. Webber N.P. et al.Atypical intradermal smooth muscle neoplasms (formerly cutaneous leiomyosarcomas): case series, immunohistochemical profile and review of the literature.Appl Immunohistochem Mol Morphol. 2013; 21: 132-138Crossref PubMed Scopus (16) Google Scholar found a similar lack of metastatic potential in their series of dermal-only atypical smooth muscle tumors. In light of these published data, in our dermatopathology practice we routinely clarify via a comment that leiomyosarcomas confined to the dermis have essentially no risk of metastasis. However, in the data presented in the study by Planet et al1Planet C. Dalle S. Dereure O. et al.Clinicopathologic and molecular analyses of cutaneous leiomyosarcoma: a retrospective, multicenter study of 79 cases.J Am Acad Dermatol. 2023; 88: 215-216Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar, it was unclear whether any of their patients with metastatic disease had primary tumors that were confined to the dermis or if they all had involvement of the subcutis. We hope that the authors will be able to clarify which if any of their metastatic cases were confined to the dermis, as this would be very important to highlight, as it would challenge the previously proposed notion that intradermal leiomyosarcomas lack metastatic potential. None disclosed. Comment on “Clinicopathological and molecular analysis of cutaneous leiomyosarcoma: A retrospective multicenter study of 79 cases”Journal of the American Academy of DermatologyPreviewTo the Editor: We thank the readers for their comments and giving us the opportunity to discuss further the outcome of cutaneous leiomyosarcoma. Full-Text PDF