Two-Day Mohs Excision of Large Scalp Dermatofibrosarcoma Protuberans Reconstructed With a Rotation Flap

Dermatofibrosarcoma protuberans (DFSP) is a rare, slow-growing, locally aggressive, cutaneous sarcoma with a high recurrence risk. Mohs micrographic surgery (MMS) offers superior margin control but presents significant reconstructive challenges in large scalp lesions. We present a 36-year-old male with a large (10 x 10 cm) DFSP of the frontal scalp requiring staged two-day MMS for complete clearance. Despite an extensive defect down to the periosteum and partial calvarium exposure, closure was achieved with a large rotational advancement flap with a split-thickness skin graft. This case highlights that even exceptionally large scalp DFSP lesions can be successfully excised under local anesthesia with MMS.