Medical Care

Liposarcoma has a number of different subtypes (ie, well differentiated, dedifferentiated, myxoid/round cell, pleomorphic), and their response to chemotherapy is not well documented.^[37]Thus, the response rates to chemotherapy of the different histological subtypes and overall and progression free survival were investigated; survival according to histological grade was also assessed. This retrospective analysis suggested that myxoid liposarcoma is relatively chemosensitive in comparison to a combination of other liposarcomas, in particular dedifferentiated and well-differentiated tumors.

In the case of well-differentiated liposarcoma, grade provides no incremental information over other histological subtypes in terms of response to therapy. In myxoid/round cell liposarcoma, the presence of a round cell component may be an adverse prognostic sign. Tumor site, a high proliferative fraction noted with MIB-1 labeling, and TP53 missense mutations are also adverse prognostic factors in myxoid/round cell tumors.^[38]

For liposarcomas, radiation therapy may be a valuable adjunct to surgery, especially in those of the myxoid variant.

The use of chemotherapy in liposarcomas remains experimental.

Although surgical resection is the mainstay of curative treatment, patients with large high-grade liposarcomas may benefit from multimodality treatment with chemotherapy and radiation.^[39]

Treatment of an atypical lipoma using liposuction has been described.^[40]

Trabectedin (Yondelis) was approved in November 2015 in the United States for unresectable or metastatic liposarcoma or leiomyosarcoma in patients who have received a prior anthracycline-containing regimen. It is an alkylating drug that binds guanine residues in the minor groove of DNA. Approval was based on a phase 3 trial (n=518) that showed a statistically significant improvement in progression-free survival compared with dacarbazine (4.2 mo vs 1.5 mo; P< .0001). No improvement in overall survival was observed.^[41]

In January 2016, eribulin (Halaven), a microtubule inhibitor,^[42] was approved by the US Food and Drug Administration (FDA) for unresectable or metastatic liposarcoma in patients who received a prior anthracycline-containing regimen. The FDA approval is based on the results from the subgroup of 143 patients with liposarcoma. In this subgroup, the results show a 7-month improvement in survival (15.6 months with eribulin compared with 8.4 months with dacarbazine). The median progression-free survival, a secondary endpoint, was 2.9 months with eribulin compared with 1.7 months with dacarbazine. However, eribulin was more toxic than dacarbazine. Treatment-emergent adverse events included neutropenia (44% vs 24%), pyrexia (28% vs 14%), peripheral sensory neuropathy (20% vs 4%), and alopecia (35% vs 3%) for eribulin compared with dacarbazine, respectively.^[43]

Comprehensive genomic profiling may facilitate targeted therapy for individual liposarcomas in the future.^[44]

Surgical Care

The rationale for wide surgical excision of atypical lipomatous tumors is the prevention of recurrence and dedifferentiation.

Wide and deep surgical excision, along with local radiation and/or chemotherapy, may be necessary for high-grade lesions.

Given the favorable outcome with wide surgical excision alone, regardless of the histologic type of the tumor, some authors believe that adjuvant radiation therapy is unjustified.

Consultations

Consultation with the following specialists may be warranted:

Oncologist: When malignancy is strongly suspected or when previous incisional biopsy reveals liposarcoma, consultation with an oncologist prior to the definitive surgical procedure is recommended.
Radiation oncologist: Adjuvant therapy may be indicated in cases in which excision is incomplete. In such cases, consultation with a radiation oncologist is recommended.

Medication

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Media Gallery

Computed tomography (CT) scan of a left thigh shows a huge mass (arrows) with predominant fat attenuation. The central soft-tissue component (asterisk) and thick, internal septations are consistent with liposarcoma.

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Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Coauthor(s)

Santiago A Centurion, MD Dermatologist, Dermatology Associates of Central NJ

Santiago A Centurion, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, American Society of Dermatopathology, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Jeffrey P Callen, MD Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American College of Rheumatology

Disclosure: Received income in an amount equal to or greater than $250 from: Biogen US (Adjudicator for study entry cutaneous lupus erythematosus); Priovant (Adjudicator for entry into a dermatomyositis study); IQVIA (Serono - adjudicator for a study of cutaneous LE) <br/>Received honoraria from UpToDate for author/editor; Received royalty from Elsevier for book author/editor; Received dividends from trust accounts, but I do not control these accounts, and have directed our managers to divest pharmaceutical stocks as is fiscally prudent from Stock holdings in various trust accounts include some pharmaceutical companies and device makers for these trust accounts for: Stocks held in various trust accounts: Allergen; Amgen; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble;; Celgene; Gilead; CVS; Walgreens; Bristol-Myers Squibb.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Jacek C Szepietowski, MD, PhD Professor, Vice-Head, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University; Director of the Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Poland

Disclosure: Received consulting fee from Orfagen for consulting; Received consulting fee from Maruho for consulting; Received consulting fee from Astellas for consulting; Received consulting fee from Abbott for consulting; Received consulting fee from Leo Pharma for consulting; Received consulting fee from Biogenoma for consulting; Received honoraria from Janssen for speaking and teaching; Received honoraria from Medac for speaking and teaching; Received consulting fee from Dignity Sciences for consulting; .

Acknowledgements

Matthew J Trovato, MD Fellow, Division of Plastic Surgery, Rutgers New Jersey Medical School

Disclosure: Nothing to disclose.