Open Access Case report

Cutaneous leiomyosarcoma arising in a smallpox scar

Robert A Pol1*, Hilde Dannenberg1, Jan-Lukas Robertus2 and Robert J van Ginkel1

Author Affiliations

1 Department of Surgery, University Medical Center Groningen, P.O. Box 30 001, Groningen, RB, 9700, The Netherlands

2 Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

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World Journal of Surgical Oncology 2012, 10:148  doi:10.1186/1477-7819-10-148

Published: 16 July 2012



Cutaneous leiomyosarcoma (CLM) is a very rare smooth muscle tumour that accounts for about 2–3% of all superficial soft tissue sarcomas. Although the development of various malignancies in scar tissue is well known, we report the first case of a CLM developing in a small pox scar.

Case presentation

A 66-year-old man presented with a painless, slow-growing lump in a small pox scar on his left shoulder. Histological biopsies showed the lesion to be a primary, well-differentiated cutaneous leiomyosarcoma. A CT scan of the thorax was conducted, which showed no signs of metastases. The complete lesion was then surgically excised, and histopathological examination revealed a radically excised cutaneous type leiomyosarcoma After 13 months’ review the patient was doing well with no evidence of tumour recurrence.


This is the first report of a CLM arising in a small pox scar. Although the extended time interval between scarring and malignant changes makes it difficult to advise strict follow-up for patients with small pox scars, one should be aware that atypical changes and/or symptoms occurring in a small pox scar could potentially mean malignant transformation.

Cutaneous leiomyosarcoma; Scar; Small pox; Treatment