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Recurrent nodule on the nasal columella: a good reason to re-biopsy


Leonard H. Goldberg, MD DermSurgery Associates 7515 Main, Suite 240 Houston, TX 77030


Background  A 15-year-old Caucasian male presented with 9-month history of a recurrent nodule on the nasal columella. The previous biopsy was reported as a neurofibroma.

Methods  Frozen sections revealed a spindle cell neoplasm. Permanent section immunohistochemistry sections stained positive for vimentin and smooth muscle actin and negative for S100 and CD34, confirming the diagnosis of leiomyosarcoma.

Results  The tumor was removed using Mohs micrographic surgery. Radiological work-up revealed no distant metastasis. There has been no local recurrence to date.

Conclusions  Leiomyosarcoma is a difficult diagnosis to make clinically and requires histological confirmation. Re-biopsy of a “benign” growth may be necessary if clinicopathological correlation does not match with the clinical behavior of the tumor in question. Finally, Mohs micrographic surgery is a useful treatment modality for leiomyosarcomas, particularly those located in cosmetically-sensitive regions of the body such as the nose.