Dermatofibrosarcoma protuberans of the head and neck is a tumor that shows extensive infiltration beyond gross margins. Wide local excision with 2- to 3-cm margins results in an unacceptably high recurrence rate; larger excisional margins are necessary to remove all disease. Accurate margin identification achieved by using Mohs surgery with rush paraffin section analysis results in complete tumor removal and excellent control rates. This method should be preferred for treatment of dermatofibrosarcoma protuberans of the head and neck.

For lesions that require immunohistochemical staining or that remain undiagnosed after fine-needle aspiration, use of core needle biopsy should be considered before excisional biopsy. Core needle biopsy is a safe, effective, time-efficient, inexpensive procedure that can be an important tool for diagnosing head and neck masses, especially when lymphoma is suspected.