Surgical treatment for dermatofibrosarcoma protuberans: the Dartmouth experience and literature review

Dermatofibrosarcoma protuberans (DFSP) is an invasive soft tissue tumor with asymmetric pattern of growth and propensity for recurrences, thus warranting systematic treatment planning at onset. We conducted a retrospective analysis of 25 patients with DFSP that received either wide excision, modified wide excision (with horizontal processing), Mohs micrographic surgery (MMS), or combination surgery. Follow-up ranged from 15-133 months, with a median of 68 months.

Fourteen patients were treated with wide excision, 4 with modified wide excision, 6 with MMS followed by modified wide excision, and 1 with MMS. No recurrences were reported. Patients with lesions arising from "cosmetically sensitive" areas (head and neck) most often underwent MMS or modified wide excision. Our study supports that all 4 surgical treatment methods were successful in achieving recurrence-free survival, but emphasis on presurgical planning and patient selection for each surgical approach is key to allow for the least complicated repair while maximizing tissue preservation.