Positive margins in excised dermatofibrosarcoma protuberans: a study of 58 cases treated with slow‐<scp>M</scp>ohs surgery

Serra‐Guillén, C.; Llombart, B.; Nagore, Eduardo; Requena, Celia; Traves, Víctor; Llorca, D.; Kindem, S.; Alcalá, Rebeca; Guillén, C.; Sanmartín, O.

doi:10.1111/jdv.12235

Cited by 7 publications

(5 citation statements)

References 14 publications

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“…Rarely does DFSP exhibits any hematogenous or lymphatic dissemination as observed by Gloster et al [39,40]. Prior any surgical procedure, magnetic resonance imaging (MRI) is important, which is extremely sensitive than physical examination, for ascertaining tumor involvement to surrounding tissues and structures especially in evaluation of lesions in locations like the head and neck regions and some upper part of the trunk [41,42]. However, Computed tomography (CT) is usually preferred in rare cases of suspected bone involvement.…”

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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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: 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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“…Deferred MMS, slow Mohs, or modified MMS (deferred formalin‐fixed, paraffin‐embedded histologic specimens) is a type of MMS used to treat skin tumors in which the interpretation of frozen sections is difficult and/or requires immunostaining. Lentigo maligna, dermatofibrosarcoma protuberans, atypical fibroxanthoma, and angiosarcoma are usually treated with deferred Mohs . In our series, this technique was used more commonly to treat SCC than BCC.…”

Section: Discussionmentioning

confidence: 87%

“…Mohs. [23][24][25] In our series, this technique was used more commonly to treat SCC than BCC. It could be due to the better histological specimens obtained with paraffin-embedding, which allows easier identification of residual SCC that can be tricky in fresh frozen sections.…”

Section: Discussionmentioning

confidence: 99%

Differences of Mohs micrographic surgery in basal cell carcinoma versus squamous cell carcinoma

et al. 2018

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Background The two main tumors treated with Mohs micrographic surgery (MMS) are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). There are no studies analyzing whether MMS is different when treating these two types of tumors. Objective We aim to compare the characteristics of the patients, the tumors, and MMS, and first‐year follow‐up of MMS in BCC and SCC. Methods REGESMOHS is a prospective cohort study of patients treated with MMS. The participating centers are 19 Spanish hospitals where at least one MMS is performed per week. Data on characteristics of the patients, tumors, and surgery were recorded. The follow‐up was done with two visits: the first visit within 1 month after surgery and the second one within the first year. Results From July 2013 to April 2017, a total of 2,669 patients who underwent MMS were included in the registry. Of them, 2,448 (93%) were diagnosed with BCC, and 181 (7%) were diagnosed with SCC. Patients with SCC were older than those with BCC (median age 73 years vs. 68 years) and presented immunosuppression more frequently. The tumor size was significantly larger in the SCC group. Regarding surgery, deeper invasion was more frequent in SCC, resulting in larger defects. Despite this, SCC did not require more stages to get clear margins or more time in the operating room. Incomplete Mohs was more frequent in the SCC group (6%) than in the BCC group (2%). The incidence of perioperative complications was higher when treating SCC. There were more relapses in the first‐year follow‐up in the SCC group. Conclusion There are significant differences when comparing MMS in BCC and SCC. Knowledge of these differences can help to prepare the patient and plan the surgery, optimizing results.

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“…Mohs micrographic surgery should therefore also be recommended for recently excised tumors with positive margins. 18 Location is also closely related to surgical difficulty. Tumors located on the head and neck usually require a higher degree of surgical complexity.…”

Section: Discussionmentioning

confidence: 99%

“…Mohs micrographic surgery should therefore also be recommended for recently excised tumors with positive margins. 18…”

Section: Discussionmentioning

confidence: 99%

Determination of Margins for Tumor Clearance in Dermatofibrosarcoma Protuberans: A Single-Center Study of 222 Cases Treated With Modified Mohs Surgery

et al. 2021

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BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is an invasive skin tumor traditionally associated with very high recurrence rates when treated with conventional surgery (CS). OBJECTIVE To calculate the minimum margin that would have been required to achieve complete tumor clearance with hypothetical CS. To analyze DFSP characteristics and Mohs micrographic surgery (MMS) effectiveness in treatment of this tumor. MATERIALS AND METHODS Minimum margin was calculated by measuring the largest distance from the visible edge of the tumor to the edge of the surgical defect. Tumor variables (age, sex, size, time since onset, and location) were correlated with surgical variables (number of stages and minimum margin). RESULTS We studied 222 cases of DFSP treated with MMS. A mean of 1.47 MMS stages and a mean minimum margin of 1.23 cm were required to achieve tumor clearance. Tumors on the head and neck required significantly more stages and a significantly wider margin. Tumor size was positively correlated with time to diagnosis, age, and number of MMS stages. CONCLUSION Tumors located on the head and neck have greater subclinical extension. Tumor size was also a predictor of surgical difficulty, but time to diagnosis was not.

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Positive margins in excised dermatofibrosarcoma protuberans: a study of 58 cases treated with slow‐Mohs surgery

Cited by 7 publications

References 14 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

Differences of Mohs micrographic surgery in basal cell carcinoma versus squamous cell carcinoma

Determination of Margins for Tumor Clearance in Dermatofibrosarcoma Protuberans: A Single-Center Study of 222 Cases Treated With Modified Mohs Surgery

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