Managing the positive periosteal margin after Mohs excision of scalp dermatofibrosarcoma protuberans in children with underlying calvarial bone thinning and resorption: The value of multidisciplinary treatment

Mohs Micrographic Surgery for Congenital Scalp Dermatofibrosarcoma Protuberans With Novel PLEKHH2–ALK Gene Fusion

“…Interestingly, the calvarium associated with this area was intact by inspection at the time of surgery, and the outer table biopsy was negative for tumor, an oddity that has been reported in another scalp DFSP case treated with Mohs micrographic surgery that had positive periosteum. 5 Reactive dural thickening and reactive fibrous change in the calvarium can occur with meningiomas. It is possible that these MRI findings may represent reactive dural thickening and reactive enhancing fibrous change permeating the relatively soft and pliable fetal/neonatal calvarium (Figure 3).…”