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Background A 15-year-old Caucasian male presented with 9-month history of a recurrent nodule on the nasal columella. The previous biopsy was reported as a neurofibroma. Methods Frozen sections revealed a spindle cell neoplasm. Permanent section immunohistochemistry sections stained positive for vimentin and smooth muscle actin and negative for S100 and CD34, confirming the diagnosis of leiomyosarcoma. Results The tumor was removed using Mohs micrographic surgery. Radiological work-up revealed no distant metastasis. There has been no local recurrence to date. Conclusions Leiomyosarcoma is a difficult diagnosis to make clinically and requires histological confirmation. Re-biopsy of a “benign” growth may be necessary if clinicopathological correlation does not match with the clinical behavior of the tumor in question. Finally, Mohs micrographic surgery is a useful treatment modality for leiomyosarcomas, particularly those located in cosmetically-sensitive regions of the body such as the nose.

A 57-year-old white man with a long history of smoking presented with a warty growth on his lower lip that had been slowly enlarging for several years. The tumor had replaced the entire vermilion border of the lip but did not appear to invade the deeper tissues or the mucosa (Fig. 1). A biopsy was consistent with verrucous carcinoma. Excision via Mohs micrographic surgery was performed and examination of the tissue confirmed the diagnosis of verrucous carcinoma (Fig. 2).