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Adequate surgical margins for dermatofibrosarcoma protuberans - A multi-centre analysis.
E A Huis In 't Veld1, D J Grünhagen2, F van Coevorden1
1Department of Surgical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
Summary
Achieving adequate margins for dermatofibrosarcoma protuberans (DFSP) requires balancing wider resections with reconstruction needs. Wider margins improve clearance but increase reconstruction necessity, without significantly impacting recurrence rates if over 1mm.
Area of Science:
- Oncology
- Surgical Pathology
- Dermatology
Background:
- Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive skin cancer.
- Adequate surgical margins are crucial for minimizing recurrence rates in DFSP.
- Achieving clear margins presents challenges in DFSP management.
Purpose of the Study:
- To evaluate the methods used to achieve adequate margins in DFSP resections.
- To determine the necessity of additional treatments for margin clearance in DFSP.
- To analyze the relationship between margin width, reconstruction, and recurrence in DFSP.
Main Methods:
- Retrospective analysis of 279 DFSP patients treated between 1991 and 2016.
- Data collected from prospectively held databases and patient files at three tertiary centers.
- Inclusion criteria: DFSP confirmed by biopsy and treated with oncological resection.
Main Results:
- 86% of DFSP cases achieved clear pathological margins after initial excision in tertiary centers.
- Wider resection margins significantly correlated with increased need for reconstructions (p=0.002).
- No significant association found between clear margin width (>1mm) and recurrence rates (p=0.710).
Conclusions:
- Wider resection margins increase the likelihood of clear pathological margins but also necessitate more reconstructions.
- The primary goal of DFSP excision should be wide surgical resection.
- Balancing resection width against reconstruction needs and surgical morbidity is essential for optimal DFSP management.
