Undifferentiated Pleomorphic Sarcoma

Metastasis

Immunosuppression

Wide local excision

Biopsy

Surgery

Scalp

Dermatology

Radiation therapy

Radiology

Lesion

Atypical fibroxanthoma

Soft tissue sarcoma

Internal medicine

Medicine

Adjuvant radiotherapy

Immunohistochemistry

Cancer

Sarcoma

Pathology

BMJ Case Reports

An 82-year-old man presented with a right scalp lesion which had been increasing in size. The patient's medical history was significant for a heart transplant 25 years before, and he was on chronic immunosuppression. Biopsy of the lesion showed atypical fibroxanthoma. The patient underwent an excision of the lesion with split thickness skin graft. Pathology showed fibroxanthoma with negative margins. Over the next 9 months, the patient developed new lesions, which were also excised to negative margins. However, with each new lesion, the histology demonstrated increasing dysplasia and ultimately pleomorphic sarcoma. The patient had a metastatic workup with CT of the chest, which was negative, and he underwent a radical scalpectomy, split thickness skin graft placement and adjuvant radiation therapy. The patient has not developed any new scalp lesions and no evidence of metastasis.

Progression of the atypical fibroxanthoma to pleomorphic dermal sarcoma in a heart transplant patient