1. Cutaneous Carcinosarcoma Katy H. Goldsborough, William B. Laskin, Jeffrey D. Wayne, Mark Agulnik Department of Medicine, Division of Hematology/ Oncology, Department of Pathology Department of Surgery, Division of Surgical Oncology Feinberg School of Medicine, Northwestern University, Chicago, IL

2. Carcinosarcomas (CS): Background Malignant neoplasm –Biphasic epithelial and mesenchymal elements –Breast, lung, urogenital, gastrointestinal –Hypothesis- Multiclonal vs. Monoclonal –IHC studies establish 2 distinct populations Primary cutaneous CS –Dawson 1972 –Basal and squamous cell carcinoma –Pleomorphic/ atypical fibroxanthoma/ MFH

3. Case Report 62 y.o. male Subcutaneous 4 mm nodule lateral to sternum Slow growth over 18 months Excisional bx followed by wide local excision p63AE1/ AE3 Cam 5.2 CK 5/6 BetaE12/ CK903 MNF116VimentinS100 BCC ++++++-- Sarcoma ------+-

4. Methods All case reports and series of CCS Search terms: »Carcinosarcoma »Carcinoma and sarcoma »Sarcomatous sarcoma »Biphasic sarcomatoid carcinoma »Spindle cell carcinoma 48 publications reviewed

5. Results Between 1972 and 2007: 74 cases of CCS have been reported. Sex- M:F49:25 Age Range (Mean)36-93 (71) Duration < 3 months 3-6 months > 6 -12 months 1-2 years > 2 years NR/UK 6 weeks- 50 yrs 10 6 5 22 26 Size < 1 cm 1-5 cm >5-10 cm > 10 cm NR/ UK 9 42 13 4 6 Epithelial BCC SCC Spiroadenocarcinoma Pilar Tumor Pilomatrix Carcinoma Porocarcinoma Adenocarcinoma 37 20 11 6 1 3 Mesenchymal Angiosarcoma Chondrosarcoma Fibrosarcoma Leiomyosarcoma Osteosarcoma Pleomorphic Rhabdomyosarcoma Spindle cell Sarcoma 1 7 1 5 24 32 4 12

6. Results TreatmentSurgery74 Radiation10 Chemotherapy2 SurvivalAWOD <6 months 6-12 months >12 months 38 4 13 21 DWOD < 12 months >12 months 716716 AWD < 12 months > 12 months 532532 DWD < 12 months > 12 months 11 9 2 Unknown13

7. Conclusions Primary CCS is a rare disease. 6 th -8 th decade of life Survival predicted by: –Epithelial component –Growth pattern –Tumor size –Duration –LN involvement –Age

8. Conclusions Treatment approach –Wide local excision –Negative margins No defined role for adjuvant radiation therapy or chemotherapy.