Sheffield 2026 Presented e-posters Thursday

To describe a rare case of pleomorphic dermal sarcoma which presented similar to a basal cell carcinoma and highlight the importance of early identification and treatment to prevent long term morbidity.

An 84 year old Caucasian man presented to the Oculoplastics clinic with a one year history of a painless, exophytic, nodular lower eyelid lesion, which had grown in the last six weeks. He denied any discharge. He had a previous history of basal cell carcinomas involving the right medial canthus and nose treated abroad. He was otherwise diabetic, had diverticulitis, and was on medication for hypertension and high cholesterol.

He underwent initial incisional biopsies which were reported as atypical fibroxanthoma/pleomorphic dermal sarcoma spectrum lesion. Immunohistochemistry was positive for CD68, CD163, CD10 (spindle/mononuclear cells), focal actin and desmin, wildtype p53 in the multinucleated giant cells. Following this, he had a CT which showed a 20mmx15mmx19mm soft tissue mass with no underlying bony involvement. The lesion was excised entirely and reported as an osteoclast-rich grade 2 sarcoma, which on the eyelid may represent a pleomorphic dermal sarcoma.

Pleomorphic dermal sarcoma (PDS) is an aggressive skin cancer that has rarely been reported in the literature, especially in the periocular area. As PDS is associated with a high local recurrence rate and metastasis, early recognition and intervention with clear surgical margins is essential to optimise patient outcomes. PDS should be considered in older Caucasian men with sun-damaged skin and rapidly growing, ulcerated, bleeding nodularlesions.