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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.

European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
|August 11, 2020
PubMed
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.

Keywords:
DFSPDermatofibrosarcoma protuberansResection marginsSurgical treatment

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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.