Adequate surgical margins for dermatofibrosarcoma protuberans – A multi-centre analysis

Veld, Eva A. Huis in ’t; Grünhagen, Dirk J.; Coevorden, Frits van; Smith, Myles; Akkooi, A. C. van; Wouters, M.; Verhoef, C.; Strauß, D.; Hayes, Andrew; Houdt, Winan J. van

doi:10.1016/j.ejso.2020.06.022

Cited by 19 publications

(15 citation statements)

References 29 publications

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“…The treatment of choice is a large surgical resection ensuring healthy margins of three to five centimeters (Chan et al, 2014), the local recurrence rate tends to decrease with increasing surgical margins but a recurrence rate of 20 to 50% in cases of incomplete resection (Al Tarakji et al, 2015). Some guidelines recommend radiotherapy in the event of incomplete and unresectable tumor resection or multiple recurrences (Huis in 't Veld et al, 2020). Adjuvant radiotherapy can effectively reduce the rate of local recurrence (Suna et al, 2000).…”

Section: Resultsmentioning

confidence: 99%

“…Adjuvant radiotherapy can effectively reduce the rate of local recurrence (Suna et al, 2000). For adjuvant chemotherapy, Imatinib has been shown to successfully inhibit the growth and survival of DFSP cells in vitro (Huis in 't Veld et al, 2020). Imatinib is one of the major targeted therapies of DFSP, its place in the management of this pathology derives directly from its mechanism of action (Pagès et al, 2013).…”

Section: Resultsmentioning

confidence: 99%

“…Hajar O et al reported that the use of Imatinib in a patient with inoperable DFSP was dramatic (Ouahbi et al, 2019). The National Comprehensive Cancer Network (NCCN) guideline recommends considering Imatinib in unresectable PSFPs due to multiple resections or unacceptable functional or aesthetic results when a new resection is performed (Huis in 't Veld et al, 2020). In our case, adjuvant chemotherapy was performed until the sixth postoperative month because the patient had already started chemotherapy two months before the surgical excision and we were also limited to a margin of two centimeters for the functional result and aesthetics of the hand afterward.…”

Section: Resultsmentioning

confidence: 99%

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Localization on the palmar face of the hand of a Darier-Ferrand dermatofiborosarcoma. About a case

Ai¹,

Ramampisendrahova

Has³

et al. 2021

JAMRMHSS

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Darier-Ferrand dermatofibrosarcoma is a rare but not exceptional malignant mesenchymal skin tumor, representing 0.1 % of malignant skin tumors. It is characterized by high recurrence, slow growth and low metastatic potential. Although several clinical cases of an unusual variant of Darier-Ferrand dermatofibrosarcoma have been reported in the literature, localization on the palmar face of the hand is not common. We report a case of Darier and Ferrand dermatofibrosarcoma at the level of the fourth commissure of the palm of the left hand in a 43- year-old young Malagasy adult treated by a large surgical excision with a healthy margin of two centimeters associated with adjuvant chemotherapy with Imatinib.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Localization on the palmar face of the hand of a Darier-Ferrand dermatofiborosarcoma. About a case

Ai¹,

Ramampisendrahova

Has³

et al. 2021

JAMRMHSS

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“…Another meta-analysis of eight observational studies revealed a significant positive correlation between a margin of more than 3 cm and the LRR and positive surgical margin rate [ 125 ]. However, the larger the surgical margin is, the more significant the cosmetic and functional problems that develop after WLE may be [ 126 ]. Recently, WLE with a lesser peripheral surgical margin has also been reported to be associated with a low LRR and a low positive surgical margin rate [ 127 , 128 ].…”

Section: Surgical Margin Of Primary Tumorsmentioning

confidence: 99%

“…Farma et al demonstrated a 97% clear histologic margin and a 1% LRR for wide local excision with a 2 cm clinical margin [ 127 ]. In contrast, Huis In’t Veld et al investigated pathologic clear margins and demonstrated no significant influence of the width of the pathologic clear margin on the LRR if the pathologic clear margin was longer than 1 mm [ 126 ], suggesting that a 1 mm pathologic clear margin might be sufficient and that additional resections or adjuvant radiotherapy might not be needed, although further studies are required to substantiate this conclusion. The authors also demonstrated that the median difference between the primary surgical macroscopic and the pathologic margin was 22 mm.…”

Section: Surgical Margin Of Primary Tumorsmentioning

confidence: 99%

Evidence from Clinical Studies Related to Dermatologic Surgeries for Skin Cancer

Ishizuki

Nakamura

2022

Cancers

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Despite the significant progress made in the past several years in pharmacotherapies for skin cancer, such as BRAF/MEK inhibitors, immune checkpoint inhibitors, and Hedgehog pathway inhibitors, surgical removal of primary skin cancer is still the first choice of treatment unless distant metastases are evident. In cases of lymph node metastases with clinically palpable lymphadenopathy, lymph node dissection (LND) is typically performed for most skin cancers. In the surgical treatment of primary skin tumors, the surgical margin is critical not only for reducing the possibility of tumor recurrence but also for minimizing the cosmetic and functional complications associated with wide local excision. In contrast, dermatologic surgery can cause various complications. Although skin graft is frequently used for reconstruction of the surgical defect, extensive graft necrosis may develop if optimal stabilization of the graft is not obtained. LND also sometimes causes complications such as intraoperative or postoperative bleeding and postoperative lymphoceles. Moreover, as in other types of surgery, surgical site infection, intraoperative anxiety, and intraoperative and postoperative pain may also develop. These complications are frequently associated with significant morbidity and discomfort. In this review, we summarize the evidence from previous clinical studies regarding the optimal surgical margin for skin cancer and the methods for diminishing the complications associated with dermatologic surgery.

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Dermatofibrosarcoma protuberans surgery: Experiences of four African surgical oncology units and literature review

Zongo

Guigemdé

Yameogo

et al. 2022

Journal of Surgical Oncology

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Background and Objectives Dermatofibrosarcoma is a locally malignant tumor. This gives surgery a place of choice. The advent of imatinib has improved outcomes. Our aim is to describe the indications, techniques and results of surgery. Methods A retrospective, multicenter, descriptive study conducted in four West African surgical oncology units. It covers dermatofibrosarcoma surgery performed between January 1, 1988 and December 31, 2020. We took into account the surgical procedure, the mode of skin coverage, adjuvant treatments and survival. Comparisons were possible using Student's t‐test and Pearson's χ2. Results We recorded 81 cases of dermatofibrosarcoma. Surgery was effective in 90.1% of cases. Wide resection was the principle with a mean resection margin of 3.8 ± 1.9 cm. healing by primary intention, flaps and healing by secondary intention were the methods of skin coverage in 30.1%, 24.7% and 41.1% respectively. The type of skin coverage was related to the topography and size of the tumor (p < 0.0001). The healing time is associated with the type of skin cover. The recurrence rate was not related to the type of skin coverage (p = 0.8). Conclusions Wide and deep resection in the absence of Mohs micrographic surgery ensures healthy margins. Oncoplasty reduces the healing time without increasing the risk of recurrence.

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Adequate surgical margins for dermatofibrosarcoma protuberans – A multi-centre analysis

Cited by 19 publications

References 29 publications

Localization on the palmar face of the hand of a Darier-Ferrand dermatofiborosarcoma. About a case

Localization on the palmar face of the hand of a Darier-Ferrand dermatofiborosarcoma. About a case

Evidence from Clinical Studies Related to Dermatologic Surgeries for Skin Cancer

Dermatofibrosarcoma protuberans surgery: Experiences of four African surgical oncology units and literature review

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