Pleomorphic dermal sarcoma (PDS) is a rare type of skin cancer that originates in the dermis, the layer of skin beneath the epidermis. This condition develops from cells within the skin itself, rather than from existing moles or pigment-producing cells.
Understanding Pleomorphic Dermal Sarcoma
Pleomorphic dermal sarcoma is classified as an intermediate-grade tumor, reflecting its behavior between benign and aggressive malignancies. It was previously recognized by other names, such as atypical fibroxanthoma or cutaneous undifferentiated pleomorphic sarcoma. This tumor typically appears as a solitary nodule or mass, often presenting on chronically sun-exposed areas of the body, most commonly the head and neck.
The term “pleomorphic” describes the varied shapes and sizes of the cells observed under a microscope, which is a distinguishing feature of this sarcoma. PDS primarily affects older adults, particularly those with fair skin and a history of significant sun exposure.
Identifying and Diagnosing PDS
Recognizing pleomorphic dermal sarcoma often begins with noticing a new or changing skin lesion that may be firm to the touch. The lesion can sometimes bleed or fail to heal over time, prompting individuals to seek medical attention. A clinical examination by a healthcare professional is the initial step in evaluating suspicious skin changes.
A definitive diagnosis relies on a biopsy, most commonly an excisional biopsy, where the entire lesion is removed for microscopic examination. A dermatopathologist, a specialist in skin pathology, then examines the tissue to confirm the presence of PDS. This pathological analysis helps distinguish PDS from other skin lesions or cancers, such as squamous cell carcinoma or melanoma, which can have similar appearances.
Treatment Approaches for PDS
The primary treatment for pleomorphic dermal sarcoma is surgical excision, aiming to remove the tumor along with a surrounding margin of healthy tissue. Achieving clear margins, meaning no cancer cells are found at the edges of the removed tissue, is important for reducing the chance of recurrence. The size and location of the tumor influence the extent of the surgical removal.
Mohs micrographic surgery may be an option for certain PDS cases, particularly those located on the head and neck, where preserving healthy tissue is a priority. This specialized surgical technique involves removing thin layers of skin and examining them immediately under a microscope until no cancer cells remain. Mohs surgery offers high cure rates for appropriately selected tumors while minimizing the removal of healthy skin.
Radiation therapy can be considered in specific situations, such as when surgical margins are not clear or for tumors that cannot be completely removed through surgery. Chemotherapy is rarely used for PDS and is typically reserved for instances where the cancer has spread to distant parts of the body, which is an uncommon occurrence. Treatment plans are tailored to each individual, considering the tumor’s characteristics like size, depth, and location, as well as the patient’s overall health.
Living with PDS: Monitoring and Prognosis
Individuals diagnosed with pleomorphic dermal sarcoma have a favorable outlook when the tumor is treated effectively. There is a possibility of recurrence, most often as a local recurrence at the original site. Distant metastasis, where the cancer spreads to other parts of the body, is far less common.
Regular follow-up examinations are necessary after treatment to monitor for any signs of recurrence or the development of new lesions. These examinations involve skin checks and, occasionally, imaging studies if there is concern about deeper involvement. Practicing sun protection, such as using sunscreen and wearing protective clothing, is also recommended to help reduce future skin damage. Early detection and appropriate management contribute to successful outcomes.