A bruise-like patch in a 4-year-old girl

Area of Science:

• Pediatric Oncology
• Surgical Pathology
• Dermatology

Background:

• Dermatofibrosarcoma protuberans (DFSP) is a rare, locally invasive sarcoma with a high recurrence rate.
• In children, DFSP may present atypically, resembling vascular malformations, leading to diagnostic delays.
• While Mohs Micrographic Surgery (MMS) is standard for adult DFSP, its application in children is limited by prolonged anesthesia concerns.

Observation:

• A case study of a 4-year-old girl diagnosed with DFSP is presented.
• The patient underwent a modified MMS procedure.
• This approach involved two shorter general anesthetic sessions.

Findings:

• The modified MMS allowed for complete examination of peripheral and deep margins.
• This technique potentially addresses the challenge of extensive subclinical extensions in pediatric DFSP.
• The modified approach balances the benefits of MMS with reduced anesthetic burden.

Implications:

• Modified MMS may be a suitable alternative for treating pediatric DFSP, ensuring complete tumor removal.
• This approach could improve outcomes for children with DFSP by minimizing recurrence risk.
• Further investigation into modified MMS protocols for pediatric sarcomas is warranted.