Surgical excision margins for fibrohistiocytic tumors, including atypical fibroxanthoma and undifferentiated pleomorphic sarcoma: A probability model based on a systematic review

Abstract

Background: Mohs micrographic surgery or wide local excision is the treatment of choice for fibrohistiocytic tumors with metastatic potential, including atypical fibroxanthoma (AFX) and cutaneous undifferentiated pleomorphic sarcoma (cUPS). Since margin clearance is the strongest predictor of clinical recurrence, improved recommendations for appropriate surgical margins help delineate uniform excision margins when intraoperative margin assessment is not available.Objective: To determine appropriate surgical wide local excision margins for AFX and cUPS.Methods: Literature search (Ovid MEDLINE, Embase, Web of Science, and Cochrane Library from inception to March 2020) to detect case-level data. Estimation of margins required using a mathematical model based on extracted cases without recurrences.Results: Probabilistic modeling based on 100 cases extracted from 37 studies showed peripheral clearance margin (ie, wide local excision margin) calculated to clear 95% of all tumors was 2 cm for AFX and 3 cm for cUPS. AFX tumors 1 cm or less required a margin of 1 cm.Limitations: Data were extracted from published cases.Conclusions: Atypical fibroxanthoma removed with at least a 2-cm peripheral excision margin is less likely to recur. Smaller tumors 1 cm or less can be treated with a more conservative margin. Margin-control surgical techniques are recommended to ensure complete removal while minimizing surgical morbidity.

Oncological Safety and Recurrence in the Surgical Treatment of Atypical Fibroxanthoma and Pleomorphic Dermal Sarcoma of the Scalp

“…However, to date, no guidelines for surgical treatment and follow-up have been established [ 23 ]. A recently published probability model based on a systemic review by Jibbe et al found peripheral excision margins of at least 2 cm for AFX and 3 cm for PDS, respectively, to reduce the recurrence rate [ 26 ]. However, the current standard of care in the treatment of AFX is due to its intermediate malignant potential, micrographically controlled excision with a narrow clearance margin appears to be sufficient [ 11 ].…”

“…However, the current standard of care in the treatment of AFX is due to its intermediate malignant potential, micrographically controlled excision with a narrow clearance margin appears to be sufficient [ 11 ]. In any case, margin-controlled surgery is favorable for ensuring complete removal and reducing resection morbidity [ 26 ]. Although the number of cases is limited, we found no local recurrence of atypical fibroxanthoma when margin-controlled surgery was performed with a margin clearance of 1.50 cm at the median (IQR 1.4–2).…”

Undifferentiated Pleomorphic Sarcoma of the Duodenal Papilla: A Rare Case and Worth Discussing History

“…There is no consensus on what is an adequate margin distance for minimizing the risk of local recurrence. When UPS occurs in the extremities, the resection margin should be at least 1–3 cm away from the gross border ( 33 , 34 ). However, if UPS is located in the retroperitoneum, complete compartmental resection will produce significantly better results ( 34 , 35 ).…”

A Multidisciplinary Approach to Complex Dermal Sarcomas Ensures an Optimal Clinical Outcome

“…No guidelines on surgical management and follow-up exist. In a recent study reviewing 100 published cases suggesting a probabilistic model, the appropriate surgical margins were found to be at least 2 cm for AFX and at least 3 cm for DUPS to clear 95% of all tumours [ 61 ]. Electrochemotherapy is a very recent potential treatment method for recurrent DUPS [ 62 ].…”