{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T05:54:38Z","timestamp":1791438878070,"version":"4.3.3"},"reference-count":45,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Dermatology"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Primary cutaneous leiomyosarcoma (LMS) is a rare smooth muscle neoplasm encompassing a spectrum of dermal and subcutaneous tumors with distinct clinical behaviors. Dermal LMS typically presents as a small, firm nodule arising from arrector pili muscle and generally follows an indolent course, whereas subcutaneous LMS originates from vascular smooth muscle and demonstrates greater infiltrative potential, larger size at presentation, and a substantially higher risk of recurrence, metastasis, and disease\u2010specific death. Histologically, LMS is characterized by intersecting fascicles of spindle cells with smooth muscle differentiation, with the diagnosis being confirmed by smooth muscle actin and desmin immunoreactivity. Recent molecular profiling has identified tumor suppressor pathway dysregulation\u2014particularly TP53 and RB1 loss\u2014and widespread copy\u2010number instability as central drivers of cutaneous LMS. Clinically, outcomes are governed principally by depth, grade, and margin status: dermal, low\u2010grade tumors rarely metastasize, whereas lesions with higher\u2010grade or subcutaneous extension account for most adverse events. Complete surgical excision with negative margins remains the cornerstone of therapy, with Mohs micrographic surgery offering precise margin control for select superficial tumors. Ongoing debate regarding the atypical intradermal smooth muscle neoplasm (AISMN) designation for dermally\u2010confined tumors reflects evolving understanding, although we argue that risk stratification is best guided by histologic features rather than nomenclature alone.\n                    <jats:boxed-text content-type=\"graphic\" position=\"anchor\">\n                      <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/ijd70471-gra-0001-m.png\">\n                        <jats:alt-text>image<\/jats:alt-text>\n                      <\/jats:graphic>\n                    <\/jats:boxed-text>\n                  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