Dermatofibrosarcoma protuberans: margins reduction using slow-Mohs micrographic surgery. Experience with 35 patients

Area of Science:

• Dermatologic Surgery
• Surgical Oncology
• Oncology

Background:

• Dermatofibrosarcoma protuberans (DFSP) is a rare, low-grade malignant mesenchymal tumor of the dermis.
• DFSP exhibits a high rate of local recurrence, necessitating wide surgical margins.
• Traditional wide excision can lead to significant tissue loss and functional impairment.

Purpose of the Study:

• To evaluate the efficacy of slow Mohs micrographic surgery (MMS) in managing DFSP.
• To assess recurrence rates and margin control using slow-MMS.
• To determine the feasibility of tissue preservation and direct closure with slow-MMS for DFSP.

Main Methods:

• A retrospective study included 35 patients with DFSP treated between 2004 and 2013.
• Slow-MMS utilizing paraffin-embedded sections was employed for tumor excision.
• Data on surgical outcomes, margin size, and recurrence were collected.

Main Results:

• A single surgical procedure was sufficient for 72% of patients.
• The median clinical excision margin was 17mm.
• No recurrences were observed after a median follow-up of 46 months, with most defects closed directly.

Conclusions:

• Slow-MMS provides effective local control of DFSP with no recurrence in this series.
• The technique allows for smaller excision margins compared to wide excision, promoting tissue sparing.
• Slow-MMS is recommended for DFSP, especially in cosmetically sensitive or functionally important areas.