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Cureus 2020 Apr 23;12(4):e7801. Epub 2020 Apr 23.

Plastic, Reconstructive and Hand Surgery, Northwell Health/Donald and Barbara Zucker School of Medicine, Staten Island University Hospital, Staten Island, USA.

Malignant fibrous histiocytoma (MFH) is an undifferentiated high-grade pleomorphic sarcoma and is considered the most common primary soft tissue sarcoma in adults. MFH is known to arise in the trunk, extremities and retroperitoneum although it can arise anywhere in the body.MFH of the skin is uncommon and even less frequent is the involvement of the scalp, especially with skull invasion. Read More

Case Rep Dermatol 2020 Jan-Apr;12(1):70-75. Epub 2020 Apr 8.

Department of Pathology, Zealand University Hospital, Roskilde, Denmark.

Cutaneous spindle cell squamous cell carcinoma (SpSCC) is a rare and often aggressive subtype of squamous cell carcinoma (SCC), which usually appears in sun-exposed areas, in areas that have received prior ionizing radiation, or in immunosuppressed individuals. SpSCCs are histologically characterized by keratinocytes infiltrating the dermis as single cells with elongated nuclei rather than as cohesive nests or islands and, in contrast to conventional SCC, are lacking features of keratinization. Immunohistochemical studies are useful to distinguish SpSCC from other spindle cell neoplasms, such as spindle cell/desmoplastic melanoma, cutaneous leiomyosarcoma, and atypical fibroxanthoma. Read More

ANZ J Surg 2020 Apr 27. Epub 2020 Apr 27.

Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.

Background: Pleomorphic dermal sarcoma (PDS) is a rare, poorly defined skin neoplasm with features similar to atypical fibroxanthoma, but with adverse histopathological characteristics indicating metastatic potential such as tumour necrosis, invasion beyond superficial subcutis or vascular and/or perineural infiltration. Optimal treatment for PDS is uncertain and reported outcomes vary due to the rarity of this diagnosis and uncertainty over histopathological categorization. The aim of this study was to review the clinical and histopathological features of PDS in a single Australian centre. Read More

Rev Med Chil 2019 Oct;147(10):1346-1349

Clínica IRAM, Santiago, Chile.

Atypical Fibroxanthoma is an unusual dermal mesenchymal tumor. It especially affects older adults and occurs in areas of sun exposure. We report a 75 years old male with a history of sun exposure without using a hat presenting with a scalp nodule. Read More

Dermatol Surg 2020 Feb 17. Epub 2020 Feb 17.

Departments of Dermatology, Pathology, and Genetics, Yale University School of Medicine, New Haven, Connecticut Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut Departments of Dermatology, Pathology, and Genetics, Yale University School of Medicine, New Haven, Connecticut Departments of Dermatology and Pathology, Yale University School of Medicine, New Haven, Connecticut Departments of Dermatology, Pathology, and Genetics, Yale University School of Medicine, New Haven, Connecticut Department of Dermatology, Vanderbilt University, Nashville, Tennessee.

Dermatol Online J 2019 Nov 15;25(11). Epub 2019 Nov 15.

University of California San Diego School of Medicine, La Jolla, CA.

Atypical fibroxanthoma (AFX) is a rare cutaneous fibrohistiocytic tumor that typically arises on chronically sun-damaged skin, such as the head and neck, as a nondescript ulcerated papule, nodule, or tumor. The clinical prognosis is usually favorable and metastasis is rare. Pleomorphic dermal sarcoma (PDS), or undifferentiated pleomorphic sarcoma, is a recently introduced diagnostic moniker for AFX-like tumors with more aggressive clinical and histologic features such as necrosis and vascular invasion. Read More

Oxf Med Case Reports 2020 Jan 31;2020(1):omz138. Epub 2020 Jan 31.

Oncology Center, Hospital Sírio-Libanês, São Paulo, Brazil.

Dermal sarcomas represent a group or rare malignancies of mesenchymal origin. Although surgical excision with wide margins can be curative, in the advanced/metastatic setting, treatment options are limited and the benefit from anthracycline-based chemotherapy or targeted agents is usually short-lived. Tumor mutational burden and PD-L1 expression scores can be used as predictive biomarker for response to immunotherapy in some metastatic cancers. Read More

Head Neck Pathol 2020 Mar 16;14(1):109-120. Epub 2020 Jan 16.

Departments of Pathology & Laboratory Medicine and Medicine, The Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.

This manuscript provides an overview of pleomorphic spindle cell tumors presenting on sun-damaged skin of the elderly and includes discussions of atypical fibroxanthoma, pleomorphic dermal sarcoma, spindle cell and metaplastic squamous cell carcinoma, spindle cell and dedifferentiated melanoma and poorly differentiated cutaneous angiosarcoma. These tumors share many of the clinical presenting and histological features, making confident diagnosis challenging. A reliable and robust diagnosis is necessary to predict behavior as the biologic potential of these tumors ranges from benign (e. Read More

J Cutan Pathol 2020 Jun 20;47(6):541-547. Epub 2020 Jan 20.

Department of Pathology and Laboratory Medicine, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.

Undifferentiated melanoma should be considered in the differential diagnosis of sarcomatoid cutaneous malignancies to ensure that patients receive the correct treatment. Dermatopathologists should recognize the pitfalls of relying too heavily on immunohistochemistry to establish this diagnosis and consider ancillary tests, including single-nucleotide polymorphism (SNP) copy number arrays and targeted next-generation sequencing (NGS), when a definitive diagnosis cannot be rendered on a primary or metastatic tumor. This technology can also help to exclude a collision of melanoma and sarcoma when both differentiated and undifferentiated components are juxtaposed. Read More

Acta Histochem 2020 Feb 27;122(2):151498. Epub 2019 Dec 27.

Pathology Unit, S. Orsola Malpighi Hospital, Bologna University, Bologna, Italy.

Dermatofibroma (BFH), atypical fibroxanthoma (AFX) and dermal pleomorphic sarcoma (DPS) are skin-based soft-tissue neoplasms of uncertain lineage. They are classified as "fibrohistiocytic" neoplasms, even if the World Health Organization stated that this term connotes a polymorphic group of lesions that histologically resemble fibroblasts and histiocytes. It is well-known that this group of lesions shows a "fibro-histiocytic-dendritic" and/or a "myofibroblastic" phenotype, even within the same lesion. Read More

Open Access Maced J Med Sci 2019 Sep 30;7(18):2982-2984. Epub 2019 May 30.

Military Medical Academy of Belgrade, Serbia, and University of Rome Guglielmo Marconi Rome, Italy.

Background: Neoplasias of the UV-exposed head-and-neck area of the elderly include non-melanoma skin cancers of various origin.

Case Report: We report two cases of rapid growing exophytic scalp tumors on chronic sun-damaged skin, in one case with a tendency of bleeding. The tumours were removed by wide surgical excision with 3D margin control, and the resulting defect was covered by a meshed split skin graft. Read More

J Dermatol 2020 Feb 17;47(2):e41-e43. Epub 2019 Dec 17.

Division of Dermatology, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, Tottori University, Yonago, Japan.

Int J Dermatol 2020 Mar 28;59(3):321-325. Epub 2019 Nov 28.

Fundación Piel Sana Academia Española de Dermatología, Madrid, Spain.

Background: The use of Mohs micrographic surgery (MMS) for rare cutaneous tumors is poorly defined. We aim to describe the demographics, tumor presentation and topography, surgery characteristics and complications of MMS for rare cutaneous tumors in a national registry.

Methods: Prospective cohort study of patients treated with MMS in Spain between July 2013 and June 2018. Read More

Cesk Patol 2019 ;55(3):182-186

Atypical fibroxanthoma (AFX) is a rare cutaneous soft tissue tumor typically occurring in the elderly on sun exposed skin. Histologically, it is composed of pleomorphic, atypical cells with multiple mitoses including atypical mitotic figures resembling undifferentiated malignant tumor. AFX is considered to be a benign tumor with almost uniformly excellent prognosis following conservative therapy if strict diagnostic criteria are applied. Read More

Mod Pathol 2020 01 25;33(Suppl 1):56-65. Epub 2019 Oct 25.

Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.

In the 2018 World Health Organization Classification of Skin Tumors, a wide range of predominantly benign mesenchymal neoplasms are included in the fibroblastic, myofibroblastic, and "fibrohistiocytic" categories. By far the most common of these tumors is dermatofibroma (fibrous histiocytoma). There are many histologic variants of dermatofibroma, some of which (cellular, aneurysmal, and atypical) are associated with a higher risk of local recurrence; these variants may be mistaken for more aggressive tumor types, including sarcomas. Read More

Postepy Dermatol Alergol 2019 Aug 30;36(4):492-494. Epub 2019 Aug 30.

Chair of Dermatology, Sexually Transmitted Diseases and Immunodermatology, Faculty of Medicine in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland.

J Cutan Pathol 2020 Feb 8;47(2):135-138. Epub 2019 Nov 8.

Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.

Transducin-like enhancer of split 1 (TLE1) belongs to the Groucho/TLE/Grg family. It functions as a transcriptional corepressor and is widely used as a biomarker of synovial sarcoma (SS). Within the skin, atypical fibroxanthoma (AFX) and dermatofibrosarcoma protuberans (DFSP) often enter the histopathologic differential diagnosis. Read More

Dermatol Surg 2019 Sep 30. Epub 2019 Sep 30.

School of Medicine, University of Texas Medical Branch, Galveston, Texas Department of Dermatology, University of Texas Medical Branch, Galveston, Texas.

Hautarzt 2019 Sep;70(9):661-669

Hautklinik, Klinikum der Stadt Ludwigshafen am Rhein gGmbH, Ludwigshafen, Deutschland.

Atypical fibroxanthoma (AFX) or undifferentiated pleomorphic sarcoma (UPS) is a rare malignant neoplastic disease of the skin. At the beginning of the 1960s AFX was described as an independent entity and superficial variant of malignant fibrous histiocytoma (MFH). Since then, many controversies on the classification have arisen mainly because in many cases dedifferentiated neoplasms from other origins were falsely diagnosed as AFX. Read More

Can J Ophthalmol 2019 08 14;54(4):e168-e170. Epub 2019 Jan 14.

Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.

Am J Dermatopathol 2019 Aug;41(8):e87-e89

Deparment of Pathology, Southern California Permanente Medical Group, Los Angeles, CA.

Atypical fibroxanthomas (AFX) are rare cutaneous tumors, which typically present as a solitary ulcerated papule or nodule on sun-damaged skin. Despite malignant-appearing features on histology, AFX typically pursue a benign clinical course. In rare instances, AFX can form collision tumors with other lesions. Read More

Ann Diagn Pathol 2019 Oct 2;42:18-32. Epub 2019 Jul 2.

The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA. Electronic address:

Multinucleated giant cells (MGC) are commonly seen in an array of neoplastic and non-neoplastic conditions, to include: granulomatous dermatitis, fibrohistiocytic lesions such as xanthogranulomas, and soft tissue tumors such as giant cell tumors of soft tissue. In addition, multinucleated giant cells are infrequently seen in melanoma, squamous cell carcinoma, and atypical fibroxanthoma. There are many different types of MGCs and their presence, cytologic, and immunohistochemical features within these pathologic entities vary. Read More

Dermatol Surg 2020 Feb;46(2):159-164

Pathology and Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, New York.

Background: Cutaneous leiomyosarcoma is a rare dermal neoplasm usually arising from the pilar smooth muscle. It is considered a relatively indolent neoplasm, and there is debate whether designation as sarcoma is appropriate. Owing to some conflicting data in the literature, however, its behavior warrants further clarification. Read More

Australas J Dermatol 2020 Feb 1;61(1):e22-e27. Epub 2019 Jul 1.

Dermatology Department, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.

Background/objectives: Atypical fibroxanthoma (AFX) is a mesenchymal neoplasm of unknown incidence. It has been determined that AFX is a tumour with low aggressiveness as long as it is properly diagnosed. Our objectives were to exclude pleomorphic dermal sarcomas or other skin tumours incorrectly diagnosed as AFX in our centre after applying strict diagnostic criteria and to assess the behaviour of appropriately diagnosed AFX. Read More

Int J Dermatol 2020 Jan 1;59(1):66-75. Epub 2019 Jul 1.

Department of Dermatology, Ankara University School of Medicine, Ankara, Turkey.

Background: Several types of dermatofibroma (DF) have been identified dermatopathologically and with dermatoscopic correlation, the dermatopathology has been predictable in limited studies so far. We identify DFs with specific dermatoscopic structures and determine the respective dermatopathological correlates.

Methods: Dermatoscopic and dermatopathologic correlation of 403 DFs were assessed. Read More

Medicine (Baltimore) 2019 Jun;98(25):e16102

Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China.

Rationale: Tumor-to-tumor metastasis is an uncommon phenomenon, and the tumor metastatic to mesenchymal tumor is extremely rare. To our knowledge, this is the first case of lung adenocarcinoma metastasizing to fibrous histiocytoma.

Patient Concerns: A 58-year-old Chinese woman was admitted to our hospital with a complaint of progressive enlargement of a mass in the right upper arm without pain, heat (localized warmth), redness, and swelling, for a year. Read More

JAAD Case Rep 2019 May 8;5(5):448-450. Epub 2019 May 8.

Pathology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy.

An Bras Dermatol 2019 Mar-Apr;94(2):239-241. Epub 2019 May 9.

Department of Dermatology, Istanbul Medipol University, Istanbul, Turkey.

Atypical fibroxanthoma is a rare superficial fibrohistiocytic tumor. Clinically, it presents itself as a painless, solitary, ulcerated, and slow-growing nodule found mainly on sun-exposed areas - especially of the head and neck - of elderly individuals. The diagnosis is based on histopathological and immunohistochemical features. Read More

Dermatol Clin 2019 Jul 16;37(3):253-259. Epub 2019 Apr 16.

Department of Dermatology, Stanford University School of Medicine, 450 Broadway Street, Pavilion C, 2nd Floor-MC5334, Redwood City, CA 94063, USA.

Atypical fibroxanthoma and undifferentiated pleomorphic sarcoma, or pleomorphic dermal sarcoma, are rare malignant cutaneous neoplasms existing along a clinicopathologic spectrum. Although these tumors share many similarities, recognition of distinguishing characteristics may predict differences in clinical behavior and outcomes. Salient features defining atypical fibroxanthoma include superficial tumors with minimal high-risk histologic features. Read More

Semin Cutan Med Surg 2019 Mar 1;38(1):E65-E66. Epub 2019 Mar 1.

Department of Dermatology, University of California San Francisco, San Francisco, CA.

Atypical fibroxanthoma (AFX) is a dermal spindle-cell sarcoma that is considered a superficial and clinically benign presentation of pleomorphic dermal sarcoma, malignant fibrous histiocytoma, and undifferentiated pleomorphic sarcoma. AFX appears clinically as a discrete red or pink nodule or papule, most commonly on the head and neck region of sun-damaged elderly patients. Histologic findings on routine hematoxylin and eosin staining reveal spindle-shaped, large, and pleomorphic tumor cells throughout the dermis. Read More

Australas J Dermatol 2019 Nov 2;60(4):327-328. Epub 2019 May 2.

Pathology Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia.

Case Rep Oncol Med 2019 28;2019:2507642. Epub 2019 Mar 28.

Medical Oncology Unit, S Andrea Hospital, Sapienza University of Rome, Rome, Italy.

Background: Atypical fibroxanthoma (AFX) is a tumor that commonly presents on the head or neck in older individuals. Making a definitive diagnosis of AFX is challenging, and frequently, it is hard to distinguish from pleomorphic dermal sarcoma (PDS). There are no clear recommendations regarding the treatment of AFX, but an extensive surgery is actually considered the best option. Read More

G Ital Dermatol Venereol 2019 Apr 23. Epub 2019 Apr 23.

Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, Reggio Emilia, Italy.

Dermatol Surg 2019 12;45(12):1450-1458

Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO.

Background: Atypical fibroxanthoma (AFX) is a rare dermal neoplasm typically occurring on sun-exposed skin in the elderly. As AFX remains a diagnosis of exclusion, updated characterization and treatment assessments are necessary to support informed diagnosis and management.

Objective: Characterization of contemporary AFX and surgical outcomes by Mohs micrographic surgery (MMS) and conventional local excision (LE). Read More

Clin Sarcoma Res 2019 14;9. Epub 2019 Feb 14.

2Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Im Neuenheimer Feld 224, 69120 Heidelberg, Baden-Württemberg Germany.

Background: Atypical fibroxanthomas (AFX) and pleomorphic dermal sarcomas (PDS) are lesions of the skin with overlapping histologic features and unspecific molecular traits. PDS behaves aggressive compared to AFX. Thus, a precise delineation, although challenging in some instances, is relevant. Read More

Australas J Dermatol 2019 Aug 21;60(3):e220-e222. Epub 2019 Feb 21.

Department of Medicine, Monash University, Melbourne, Victoria, Australia.

Atypical fibroxanthoma (AFX) remains a rare cutaneous dermally based fibrohistiocytic tumour with high rates of local recurrence. Mohs micrographic surgery (MMS) and wide local excision (WLE) with margins 1-2 cm are two surgical options. It is unclear whether timing of recurrence following surgical excision of AFX differs according to technique. Read More

Int J Surg Pathol 2019 Aug 14;27(5):518-520. Epub 2019 Feb 14.

1 University of Montreal, Montreal, Quebec, Canada.

We report the case of a 94-year-old man with a rapidly growing nodule on the preauricular area, which on histology showed a poorly differentiated spindle cell tumor with negative p63 and p40 antibody immunostains, negative high- and low-molecular-weight cytokeratins albeit for a focal expression of cytokeratin AE1/AE3. Spindle cell melanoma, angiosarcoma, and leiomyosarcoma were excluded. We explore the diagnostic approach to this challenging conundrum. Read More

Oncol Lett 2019 Feb 27;17(2):1768-1776. Epub 2018 Nov 27.

Department of Otorhinolaryngology, Head and Neck Surgery, Saarland University Medical Center, D-66421 Homburg, Germany.

Atypical fibroxanthoma (AFX) is a rare mesenchymal tumor with predominance in older male patients located mainly in chronically UV-exposed skin. Differentiation from clinically more aggressive pleomorphic dermal sarcoma (PDS) is still under debate and immunohistochemical markers are not available yet. An immunohistochemical study, including 41 cases of AFX was conducted to investigate the expression of 3q encoded oncogene in AFX and determine the associations with histomorphologic, clinical and viral parameters. Read More

J Dtsch Dermatol Ges 2018 Dec;16(12):1434-1442

Department of Dermatology, Eberhardt Karls University, Tübingen Germany.

Background: Cutaneous sarcomas are rare and characterized by pathogenetic heterogeneity. Knowledge about local infiltration patterns and recurrence rates may be useful in improving patient care and outcomes. The objective of the present study was to compare these two characteristics in sarcomas that had been treated using the identical surgical procedure. Read More

Dermatol Surg 2018 12;44(12):1644-1646

Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.

Australas J Dermatol 2019 May 26;60(2):e127-e131. Epub 2018 Nov 26.

Dermatology Department, Hospital General Universitario de Alicante, Alicante, Spain.

Background/objectives: The aim of this study was to evaluate the morphological findings of lipidised dermatofibromas under dermoscopic observation.

Methods: Dermoscopic examination of 13 cases of lipidised dermatofibromas was performed to evaluate specific dermoscopic criteria and patterns.

Results: The most frequently occurring dermoscopic features were as follows: (i) A yellowish homogenous pigmentation in all cases (100%); this pigmentation was total in 30. Read More

Actas Dermosifiliogr 2019 Jan - Feb;110(1):4-11. Epub 2018 Nov 5.

Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.

There are 3 types of leiomyosarcoma of the skin: dermal, subcutaneous, and metastatic cutaneous. Dermal leiomyosarcoma arises from smooth muscle fibers in arrector pili muscles, genital dartos muscles, and the nipple-areola complex. It is an intermediate-grade tumor associated with a tendency for local recurrence (24%) and low metastatic potential (4%). Read More

Exp Dermatol 2019 01 13;28(1):66-71. Epub 2018 Dec 13.

Department of Dermatology, University Medical Center Regensburg, Regensburg, Germany.

Background: In humans, there are four known proton-sensing G-Protein-coupled receptors (pH-GPCRs): GPR4 (GPR19), TDAG8 (GPR65, T-cell death-associated gene 8), OGR1 (GPR68, ovarian cancer GPCR1) and G2A (GPR132, G2 accumulation protein). They are known to be involved in sensing changes of extracellular proton concentrations in the acidic microenvironment of tumors, which leads to altered cell proliferation, migration, metastasis, immune cell function and inflammation. However, little is known about the expression of pH-GPCRs in the skin and especially skin cancers. Read More

Cureus 2018 Jul 13;10(7):e2979. Epub 2018 Jul 13.

Dermatology, Massachusetts General Hospital, Boston, USA.

Pleomorphic dermal sarcoma (PDS) is a rare mesenchymal tissue tumor. Distinguishing PDS from similar conditions, such as atypical fibroxanthoma (AFX), its less aggressive tumor counterpart, is difficult, as they are clinically and histologically similar. We present a case of a 77-year-old man presenting with a large nodular scalp lesion of three weeks duration. Read More

Int J Dermatol 2019 Feb 6;58(2):190-193. Epub 2018 Sep 6.

Department of Dermatology, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.

Background: Nodular fasciitis is a benign pseudosarcomatous, self-limited, and reactive process. Based on its clinical and histological features - a fast-growing, solitary tumor with high cellularity and mitotic count - nodular fasciitis is considered to be a benign mimic of sarcoma.

Methods: We present four cases of nodular fasciitis and a review of the literature. Read More

J Cutan Pathol 2018 Dec 27;45(12):880-885. Epub 2018 Sep 27.

Institute of Pathology, University Hospital Cologne, Cologne, Germany.

Background: Atypical fibroxanthomas (AFXs) and pleomorphic dermal sarcomas (PDSs) are UV-induced pleomorphic skin tumors with a non-specific immunoprofile. For that reason, exclusion of other dedifferentiated tumor entities by immunohistochemistry is still mandatory to avoid misdiagnosis.

Methods: We determined the expression frequency of several melanocytic and myofibroblastic markers investigating 50 AFXs and PDSs. Read More

Dermatol Surg 2018 Sep;44(9):1229-1231

Department of Dermatology, Columbia University Medical Center, New York, New York.

Clin Exp Dermatol 2019 01 21;44(1):86-88. Epub 2018 Aug 21.

Institute of Dermatology, Department of Clinical-Surgical, Diagnostic and Pediatric Science, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.

Am J Dermatopathol 2019 Mar;41(3):221-229

Department of Pathology and Dermatopathology, Albany Medical College, Albany, NY.

Malignant melanoma (MM) may display highly variable phenotypic diversity, sometimes associated with loss of immunohistochemical melanocytic markers and acquisition of nonmelanocytic lineage of differentiation. Primary cutaneous MM with rhabdomyosarcomatous differentiation is extremely rare with only 5 reported cases in the literature. To date, a chronological progression of a MM to rhabdomyosarcoma has not been conclusively documented. Read More