Management of dermatofibrosarcoma protuberans of the face using lower trapezius musculocutaneous pedicle flap reconstruction: a case report

Terro, Wahid; Hamadeh, Nizar; Terro, Miray

doi:10.1093/jscr/rjy089

Cited by 4 publications

(7 citation statements)

References 8 publications

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“…The excision included some branches of the facial nerve. In view of the resultant large defect and inability to adequately rotate local tissue, thus a lower trapezius musculocutaneous pedicle flap from the back was deployed and there was no evidence of recurrence after 32 months of follow-up [2]. Other authors have described cases in the head and neck zones [7,8,82].…”

Section: Current Status Of Knowledgementioning

confidence: 99%

“…It was first described by Darier and Ferrand however Hoffman officially coined the term dermatofibrosarcoma protuberans [4]. DFSP, described as a slow-growing low-grade cutaneous sarcoma [5] that often presents or has a predilection on the following sites: trunk and proximal extremities [6], less frequently on the head and neck regions [2,7,8]. DFSP has a very low potential to metastasize but with significant subclinical tentacular extensions and great capacity for local destruction as evidenced by Acosta et al [9].…”

Section: Introductionmentioning

confidence: 99%

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The efficacy of Mohs micrographic surgery over the traditional wide local excision surgery in the cure of dermatofibrosarcoma protuberans

2019

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Usually most patients with dermatofibrosarcoma protuberans (DFSP) may present rather late when the tumor is in protuberant phase due to its rarity and indolent onset. It has a high propensity for local recurrence and destructive nature. Management of DFSP requires a biopsychosocial and Multidisplinary approach regardless of the clinical or immunohistochemical variant. Surgery is the Gold standard management of localized disease. DFSP rarely exhibits any lymphatic or hematogenous dissemination. It is because of its high recurrence rate associated with Wide Local Excision (WLE), the introduction of Mohs micrographic surgery (MMS) has really helped in reducing the rates of recurrence of DFSP. Thus, the aim of this meta-analysis and systemic review is to advocate for MMS over WLE for DFSP and other cutaneous malignancies using DFSP as a prototype. The objective of this study were to conduct a meta-analysis on comparative surgical methods used in the cure of DFSP with regards to WLE verses MMS, to evaluate the cure rates with relation to recurrence rates, offer a recommendation on the various treatment modalities based on the location of lesion, and use of adjuvant therapy in different clinical-medical setups. A comprehensive retrospective analysis search in EMBASE, Google Scholar and Medline (PubMed) for studies published from 2008 to 2018 containing the surgical management of DFSP with WLE verses MMS were reviewed. Five studies of moderate-quality evidence (level B) with a pooled patient load of 684 was analyzed and found for recurrence of DFSP after WLE and MMS to be 9.10% and 2.72% respectively after an average follow-up time for both groups of 5.32 years with a female predominance of 1.58. The trunk is the commonest site for the DFSP lesion which was at 52.80% then the upper and lower extremities zones and the head and neck zones at 31.75% and 15.45% respectively. The pooled adjusted odds ratio (OR) analysis indicated that there was a direct relationship with regards the reduced recurrence rate of DFSP in the MMS group compared to the WLE group (OR:0.31;95%; CI :0.17-0.56). Furthermore, there was significant association between the reduced recurrence rate with the MMS in DFSP patients with a statistical P-value of 0.0001 at 95% CI. The expected increased recurrence rate by zones was in WLE head and neck zone at 38.19% then trunk and extremities zone at 13.34%. In the MMS group it was at of 23.4% as compared to 16.0% in the head and neck zone. Mohs Micrographic Surgery (MMS) is more efficacious in the cure rate and recurrence reduction of DFSP and should be advocated for as first line therapy especially in high recurrence prone zones.

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Section: Current Status Of Knowledgementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The efficacy of Mohs micrographic surgery over the traditional wide local excision surgery in the cure of dermatofibrosarcoma protuberans

2019

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“…Lesions may increase to a typical size of up to 5 cm in diameter and may infiltrate underlying soft tissue. Tumors of over 10 cm are very uncommon [ 2 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous neoplasm of the dermis. It is slow growing but locally aggressive with the potential to deeply infiltrate underlying structures [ 1 , 2 ]. Typically, DFSP develops between the ages of 25 and 50; however, it can occur at any age without difference in prevalence between genders [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…It is slow growing but locally aggressive with the potential to deeply infiltrate underlying structures [ 1 , 2 ]. Typically, DFSP develops between the ages of 25 and 50; however, it can occur at any age without difference in prevalence between genders [ 2 ]. Only 10–15% of cases affect the head-and-neck region; the trunk and extremities as the most common sites [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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Reconstruction of facial dermatofibrosarcoma protuberans using an anterolateral thigh flap: a case report and literature review

Besharah

Ghazzawi

Alkaff

et al. 2020

Journal of Surgical Case Reports

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Dermatofibrosarcoma protuberans is a rare, locally aggressive cutaneous malignancy with a high rate of recurrence if the head-and-neck region is involved. Treatment is challenging as it is difficult to avoid poor aesthetic and functional outcomes using the standard approach of complete resection with negative margins and subsequent reconstruction. This is especially challenging in cases where the face is involved and the defect is large after resection. There have been few cases of reconstruction using different flaps reported. We present the case of a young lady with a large cheek tumor, which was reconstructed using an anterolateral thigh flap. Excellent functional and aesthetic outcomes were achieved.

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

Asilian

Honarjou

Faghihi

et al. 2020

J of Cosmetic Dermatology

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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.

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Management of dermatofibrosarcoma protuberans of the face using lower trapezius musculocutaneous pedicle flap reconstruction: a case report

Cited by 4 publications

References 8 publications

The efficacy of Mohs micrographic surgery over the traditional wide local excision surgery in the cure of dermatofibrosarcoma protuberans

The efficacy of Mohs micrographic surgery over the traditional wide local excision surgery in the cure of dermatofibrosarcoma protuberans

Reconstruction of facial dermatofibrosarcoma protuberans using an anterolateral thigh flap: a case report and literature review

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

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