An experience of slow‐Mohs micrographic surgery for the treatment of Dermatofibrosarcoma protuberans: A long‐term cohort study

Abstract

Background Dermatofibrosarcoma protuberans (DFSP) is a rare dermal mesenchymal tumor known as a low‐grade, slow‐growing malignancy. The local invasion and high rate of recurrence following surgical treatment are the main concerns to plan the best surgical approach of treatment. Aims In the current study, it is aimed to provide an experience of slow‐Mohs surgery for the treatment of patients with DSFP. Patients/Methods Number of 25 patients with the diagnosis of DFSP through histological and immunostaining study was included. The slow‐Mohs was performed by excision of the tumor with margins accounting for 1–2 cm from both the tumor margins and three‐dimensional thickness. The obtained tissue margins were horizontally, and if any of the specimens was not margin‐free, the procedure was repeated. The patients' opinion about the procedure was assessed using Patient‐Observer Scar Assessment Scale (POSAS). Results Number of 25 patients were included and followed for a median of 46.9 months. The median of the area of excision was 35.56 cm2, and the median clinical excision margins were 19 mm (tumor excision margins + thickness of the three‐dimensional excision). The surgery was performed once for 16 (64%), and postoperative skin closure within 5–7 days after the procedure was performed for 19 (76%) patients. None of the patients represented any recurrence. The patients' overall opinion and satisfaction POSAS score accounted for 2.3 ± 1.65 and 1.6 ± 0.59, respectively. Conclusion The findings of the current study are in favor of slow‐Mohs surgery for the management of DFSP, while more extensive studies are strongly recommended for generalization of this procedure.

Mohs micrographic surgery in dermatofibrosarcoma protuberans: Rate and risk factors for recurrence in a prospective cohort study from the Spanish Registry of Mohs Surgery (REGESMOHS) and review of the literature

“…On the paraffin section, a transition zone between tumor and normal tissue was easily identified; this zone was ill defined on the frozen section, even with immunohistochemistry CD34 staining, and normal skin showed scattered spindle dermal cells that could lead to confusion. Consequently, some authors suggested that slow MMS should be considered the optimal option for MMS 11,17‐22 . However, this statement was not supported by scientific evidence that confronted both techniques, until Lee et al 7 did.…”

Cells to Surgery Quiz: October 2021

“…Dermatofibrosarcoma Protuberans: Dermatofibrosarcoma protuberans (DFSP) is a low-grade, slow-growing cutaneous mesenchymal tumor with irregular borders and finger-like extensions into surrounding and deep tissues (Verma et al, 2020). DFSP often presents as an indurated plaque or nodule with minimal symptoms (Asilian et al, 2020). This tumor, as the most prevalent cutaneous sarcoma, accounts for 2% of all sarcomas, with an incidence of 0.8-4.2 cases per million persons annually (Lemm et al, 2009).…”

Surgical management of dermatofibrosarcoma protuberans

“…40 They report the improved definition of paraffin sections allows for smaller margins with a median of 1.7 cm; however, the median time to receiving pathological results was 5 days (range 0-13) and 28% had to undergo more than 1 surgery. Asilian et al 41 recently published a review of 25 patients at a single center treated with slow-MMS with complete local control at 46.9 months and median margins of 1.9 cm. Although there are some benefits to slow-Mohs, it is more expensive, time-consuming, and may require patients to return for multiple surgeries, all of which limit the practicality of widespread use of this technique.…”