Mohs Micrographic Surgery for Dermatofibrosarcoma Protuberans in 15 Patients: The University of Arkansas for Medical Sciences Experience

Abstract

Background: Dermatofibrosarcoma protuberans (DFSP) is an uncommon, locally aggressive malignancy with wide local excision (WLE) or Mohs micrographic surgery (MMS) representing the treatment of choice. This article illustrates the experience of a single academic institution in treating DFSP with MMS and adds two particularly large, difficult closures of the glabella/central forehead and sternum to the body of literature.Objective: To report the results of 15 patients with DFSP treated with MMS over a five-year period by a single Mohs surgeon at the University of Arkansas for Medical Sciences (UAMS).Methods: A total of 15 patients between the ages of 16 and 80 years were diagnosed with DFSP and treated with MMS and were contacted in October 2021 to assess for recurrence.Results: None of the 15 patients had a recurrence of DFSP following MMS, with a mean follow-up interval of 22.4 months and an average of 1.93 Mohs layers required for tumor clearance.Conclusion: This experience reaffirms that MMS is an effective treatment for DFSP and adds additional examples of closure techniques of large, ovoid surgical defects on the glabella/central forehead and sternum to the literature.

A 73-Year-Old Female Diagnosed With Dermatofibrosarcoma Protuberans in the Primary Care Setting: A Case Report and Literature Review of Misdiagnosed Cases

“…Standard treatment for DFSP involves surgical resection by either WLE with margins or MMS [ 2 , 4 ]. In certain clinical cases and non-resectable tumors, targeted therapy with imatinib and radiation has also been used [ 2 , 7 ]. While WLE was previously the standard of care, it was associated with high recurrence rates [ 4 ].…”

“…Although DFSP has a relatively good prognosis, it has a high propensity for recurrence and a rare potential for distant metastasis [2][3][4]. Standard treatment for DFSP involves complete surgical resection by either wide local excision (WLE) with margins or Mohs micrographic surgery (MMS) [2,7]. This report highlights a case of DFSP diagnosed in the primary care setting, reviews the presentation, pathogenesis, diagnosis, and treatment of DFSP, compares DFSP to common conditions in its differential diagnosis, and reviews the literature on misdiagnosed and mismanaged cases of DFSP and their outcomes.…”

“…The diagnosis of DFSP is often delayed as it clinically mimics non-malignant dermatological pathologies such as keloid, epidermal cyst, or dermatofibroma [ 7 ]. A dermoscopy is a valuable tool in tumor recognition and findings may prompt neoplasm diagnosis [ 5 ].…”