Related Experiment Video
Updated: May 20, 2026
A Mouse Model of Incompletely Resected Soft Tissue Sarcoma for Testing (Neo)adjuvant Therapies
Published on: July 28, 2020
Systematic Review Comparing Wide Local Excision and Mohs Micrographic Surgery for Pleomorphic Dermal Sarcoma
Jason Sivieng1, Ahmed Abid2, Ali Abid1,2,3
1Department of Plastic and Reconstructive Surgery, Liverpool Hospital, Sydney, New South Wales, Australia.
Background:
Pleomorphic dermal sarcoma (PDS) is a rare cutaneous sarcoma with locally aggressive behaviour and metastatic potential. Optimal surgical management remains uncertain, with both wide local excision (WLE) and Mohs micrographic surgery (MMS) used in clinical practice. This systematic review aimed to compare oncological outcomes following WLE and MMS for PDS.
Methods:
A systematic literature search was conducted in multiple databases from inception to December 2025. Studies reporting histologically confirmed PDS treated with WLE and/or MMS and including recurrence and/or survival outcomes were eligible. Methodological quality was assessed using Joanna Briggs Institute critical appraisal tools.
Results:
Thirteen retrospective studies comprising 543 patients were included. PDS predominantly affected elderly patients and mostly involved the head and neck, particularly the scalp. WLE was the primary surgical modality, while MMS was reported in two studies. Local recurrence rates following WLE ranged from 4.2% to 69%, with higher rates observed in cohorts including incomplete excision, satellite metastases, or recurrent disease. Median time to recurrence was typically within the first year. MMS series reported recurrence rates between 12.5% and 20.9%, though interpretation was limited by small sample sizes, heterogeneous baseline disease, and confounding by indication. Metastatic rates ranged from 0% to 19%, and disease-specific mortality was uncommon but occurred predominantly following distant metastases.
Conclusion:
Complete surgical excision with clear margins remains the cornerstone of PDS management. While MMS may be considered in selected cases, particularly in anatomically constrained sites, current evidence is insufficient to support its routine use over WLE. Further multicentre studies are required to better define optimal surgical strategies.
Insights
This review compared wide local excision (WLE) and Mohs micrographic surgery (MMS) for pleomorphic dermal sarcoma (PDS). Current evidence suggests complete excision is key, but MMS is not yet proven superior to WLE for PDS.
Area of Science:
- Dermatology
- Surgical Oncology
- Cutaneous Malignancies
Background:
- Pleomorphic dermal sarcoma (PDS) is a rare, aggressive skin cancer with metastatic potential.
- Optimal surgical treatment for PDS, including wide local excision (WLE) and Mohs micrographic surgery (MMS), is not well-established.
Purpose of the Study:
- To systematically review and compare oncological outcomes of WLE versus MMS for PDS management.
- To evaluate recurrence and survival rates following different surgical modalities for PDS.
Main Methods:
- A systematic literature search was performed across multiple databases up to December 2025.
- Included studies reported histologically confirmed PDS treated with WLE and/or MMS, with recurrence and/or survival data.
- Methodological quality was assessed using Joanna Briggs Institute tools.
Main Results:
- Thirteen retrospective studies involving 543 patients were analyzed.
- PDS primarily affects elderly individuals, often on the head and neck (scalp).
- Wide local excision (WLE) showed variable local recurrence rates (4.2%–69%), influenced by completeness of excision and disease characteristics. Mohs micrographic surgery (MMS) data were limited by small sample sizes and confounding factors, with reported recurrence rates of 12.5%–20.9%. Metastatic rates were up to 19%, and disease-specific mortality was uncommon.
Conclusions:
- Complete surgical excision with clear margins is essential for managing PDS.
- While MMS may be suitable for specific cases, particularly in challenging anatomical locations, current evidence does not support its routine use over WLE.
- Further multicenter research is needed to establish optimal surgical strategies for PDS.
