Micrographic Surgery Allows Fascia Preservation in Dermatofibro­sarcoma Protuberans

Abstract

Removal of the deep fascia is recommended in therapy for dermatofibrosarcoma protuberans, but its necessity in the context of micrographic surgery is unclear. A retrospective clinicopathological analysis of 48 patients with dermatofibrosarcoma protuberans treated by micrographic surgery was performed, to determine in which tumours fascia preservation was feasible and safe. Histologically, 93% of tumours on the trunk and extremities and 14% of tumours in the head and neck region were fully located above the fascia. Localization on the head and neck was the only significant risk factor for tumour extension beyond the subcutis ( p <0.001). Overall, 44% of tumours were completely excised above the fascia and 56% with deeper excisions. Two deeply infiltrating tumours (4%) on the head recurred, but in none of these lesions was the fascia spared. These results show that micrographic surgery allows fascia preservation in superficial tumours outside the head and neck region.

A Case of Primary Dermatofibrosarcoma Protuberans of the Lower Anterior Abdominal Wall Treated by Abdominoplasty

“…The topography of DFSP has an important therapeutic and prognostic implications. Cervical location is associated with the worse prognosis as it has the highest recurrence rate, this has been linked to a higher rate of fascial infiltration at presentation, on the other hand anterior abdominal wall lesions rarely infiltrate down to the deep fascia [7]. The variation in the rate of fascial involvement is inversely Proportional to the thickness of Subcutaneous superficial fasciae.…”

“…The variation in the rate of fascial involvement is inversely Proportional to the thickness of Subcutaneous superficial fasciae. Topography also dictates the preferred reconstructive strategy of the resultant post excisional defects [7,11,13].…”

“…The lesions usually start as discolored cutaneous plaques or nodules that enlarge slowly over time and can attain large sizes. The tumors metastasize in less than 5% of all cases but have a challenging Loco-regional behavior due to their peculiar growth pattern, which is characterized by a tentacular, frond -like projections into surrounding tissue that extend variable distances from the main tumoral mass [5][6][7]. Such growth pattern is often indiscernible clinically or on imaging Faculty of Surgery, Department of General Surgery, Farwaniyah Hospital, Sabah Alnasser, Block 6, PO Box 13373 Farwaniya 81004, Kuwait and necessitate a careful histological assessment of margins to ensure adequate oncological excision [5].…”