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Peripheral excision margins for dermatofibrosarcoma protuberans: a meta-analysis of spatial data
Zebadiah Kimmel1, Desiree Ratner, John Y S Kim
1Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Annals of Surgical Oncology
|May 1, 2007
Summary
Dermatofibrosarcoma protuberans (DFSP) often shows asymmetry. Wide local excision is crucial for complete tumor clearance, as standard margins may not suffice for larger or irregular DFSP.
Area of Science:
- Oncology
- Surgical Pathology
- Dermatopathology
Background:
- Dermatofibrosarcoma protuberans (DFSP) is a rare skin cancer.
- Tumor asymmetry is a common characteristic of DFSP.
- Optimal surgical strategies for DFSP require careful margin assessment.
Purpose of the Study:
- To analyze DFSP datasets for typical asymmetry.
- To determine the optimal surgical approach for DFSP extirpation.
- To evaluate the effectiveness of lateral margin clearance in DFSP surgery.
Main Methods:
- Systematic review of MEDLINE for DFSP case series (1994-2004).
- Inclusion criteria: availability of 2D preoperative tumor size and postoperative wound defect dimensions.
- Direct contact with authors for unpublished raw data from four qualifying case series.
Main Results:
- Analysis of 98 DFSP tumors, calculating tumor index and clearance margins.
- Assessed the relationship between apparent tumor size and surgical margin.
- A 4 cm wide excision margin predicted 95% clearance for tumors ≤3 cm x 3 cm.
Conclusions:
- A weak correlation exists between preoperative DFSP size and final defect width post-excision.
- Very wide local excision is generally necessary for complete DFSP clearance.
- Surgical planning must account for potential tumor asymmetry and subsurface extension.
