Cutaneous Carcinosarcoma: A Small Case Series and Review of the Literature of a Rare Skin Tumor

Abstract

Carcinosarcomas are composed of epithelial and mesenchymal elements and primarily present within visceral organs. Despite being potentially aggressive, they are a rare diagnosis in the skin, and few manifestations have been reported to date. In this report, we describe two separate cases of carcinosarcoma presenting as nonhealing scalp wounds. Patient A: a 57-year-old male with a nonhealing skin lesion of ten years successfully treated with wide-local excision and local ortichochea flap reconstruction. Patient B: a 75-year-old female that presented with a painless, slow-growing hemorrhagic mass of 7 years invading the skull and dura ultimately requiring craniectomy and free-tissue transfer with anterolateral thigh flap. Cutaneous carcinosarcomas have more favorable outcomes due to low metastatic rates likely due to earlier detection, but delayed presentation can be fatal. Histopathological analysis is critical for determining diagnosis and prognosis. Adequate reconstruction after wide base excision varies and follows the reconstructive ladder/elevator ranging from primary closure up through free-tissue transfer. With cutaneous manifestations of carcinosarcoma seldom reported in the literature, it is our hope that reporting unusual instances such as this will raise awareness and allow for earlier diagnoses, treatments, and reconstructions.

Keywords: cutaneous carcinosarcoma; sarcomatoid carcinoma; skin cancer.

Figure 1. Patient A: (A) pre-excision, (B) post-excision defect illustrating exposed bone devoid of pericranium, and (C) reconstructed scalp wound with local tissue rearrangement (ortichochea flap)

Figure 2. Patient A: (A) a representative routine H&E section at 20x showing spindled and undifferentiated histomorphology classically seen in carcinosarcoma and (B) a representative immunohistochemical stain at 10x showing variable p63 positivity targeting the diagnosis of carcinosarcoma

H&E, hematoxylin and eosin

Figure 3. Patient B: (A) basal cell carcinosarcoma showing biphasic cytology at 20x and (B) differential cytokeratin immunostaining at 20x magnification with sarcomatoid cells staining negative

Figure 4. Patient B: Computed tomography scan in the (A) axial, (B) coronal and (C) sagittal views illustrating cranial bone and brain involvement of carcinosarcoma