A single-institutional review of 68 patients with dermatofibrosarcoma protuberans: wide re-excision after inadequate previous surgery results in a high rate of local control

Harati, Kamran; Lange, Katrin; Goertz, Ole; Lahmer, A.; Kapalschinski, Nicolai; Stricker, Ingo; Lehnhardt, Marcus; Daigeler, Adrien

doi:10.1186/s12957-016-1075-2

Cited by 35 publications

(27 citation statements)

References 34 publications

(53 reference statements)

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“…Consequently, we would advocate using a margin width of at least 2 cm and scrupulous histopathological examination with re-excision upon close (R0) margins to achieve adequate results. This finding concurs with the recommendations of Harati et al 19 who also suggest 2-3-cm margins, as well as with the National Comprehensive Cancer Network (NCCN) Guidelines. Achieving adequate resection margins is key since recurrence is linked to positive margins.…”

Section: Discussionsupporting

confidence: 91%

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Challenging Dermatofibrosarcoma Protuberans- Surgical Management

Goud¹,

Ali²,

Sivender³

2020

jebmh

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BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a rare, variable grade malignant mesenchymal tumor of the soft tissue, characterized by slow infiltrative growth. It has a high chance of common local recurrence, with rare distant metastases. METHODS We present a retrospective study of twelve patients who were diagnosed with DFSP and operated at our institution in the last 10-year period. We examined the clinicopathological parameters with special emphasis on the margin status regarding the clinical outcome and the follow-up. RESULTS A total of 8 cases underwent re-excision at our institution following primary excision or incisional biopsy performed at a different institution. Seven cases received excision after incisional biopsy at our institution. Five patients developed recurrent disease following primary excision with histological R0 margins at other institutions and received re-excision at our institution. All excisions at our institution resulted in R0 margins with no recurrence recorded at last follow-up (6 to 175; mean 84 months). The mean margin for those who received resection at our institution was 1.67 cm. Negative margins upon primary excision were achieved using a mean margin width of 2.04 cm. Most common tumor localization was the trunk (11 cases). CONCLUSIONS Awareness of this rare entity is important for a prompt diagnosis and a proper management of the disease. The greatest clinical challenge in the management of DFSP is achieving local control. Complete excision of the tumor with surgical margin widths of at least 2 cms is recommended.

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Section: Discussionsupporting

confidence: 91%

“…Moreover, complex or large tumors may be resectable only or in combination with wide excision. 15,[19][20][21] MMS was not applied at our institution. In our study, however, 12 out of 20 patients required plastic reconstruction due to large defects caused by excision with safety margins of 1-3 cm.…”

Section: Discussionmentioning

confidence: 99%

Challenging Dermatofibrosarcoma Protuberans- Surgical Management

Goud¹,

Ali²,

Sivender³

2020

jebmh

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“…Past studies of our institution which have determined the influence of negative margin widths in STS, in general, could not establish a relationship between margin widths and outcome [24,25]. However, analyses of STS subsets such as angiosarcoma and dermatofibrosarcoma protuberans revealed that margin widths may indeed have an impact on specific entities [26][27][28]. Therefore, it is crucial to analyze the entities separately and to assess the prognostic significance of treatment-related factors for every histologic subset specifically.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Surgical Margins and Adjuvant Radiotherapy in Patients with Undifferentiated Pleomorphic Sarcomas of the Extremities: A Single-Institutional Analysis of 192 Patients

Goertz

Pieper

Lohe

et al. 2020

Cancers

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Background: Undifferentiated pleomorphic sarcomas are a frequent subtype within the heterogeneous group of soft tissue sarcomas. As the attainment of negative margins can be complicated at the extremities, we determined the prognostic significance of surgical margins in our patient population. Methods: We retrospectively determined the relationship between local recurrence-free survival (LRFS), overall survival (OS), and potential prognostic factors in 192 patients with UPS of the extremities who were suitable for surgical treatment in curative intent. The median follow-up time was 5.1 years. Results: The rates of LRFS and OS after 2 years were 75.7% and 87.2% in patients with R0-resected primary tumors and 49.1% and 81.8% in patients with R1/R2-status (LRFS: p = 0.013; OS: p = 0.001). Adjuvant radiotherapy significantly improved LRFS (5-year: 67.6% vs. 48.4%; p < 0.001) and OS (5-year: 82.8 vs. 61.8; p = 0.016). Both, negative margins and adjuvant radiotherapy were found to be independent prognostic factors in multivariate analysis. Conclusions: The data from this study could underscore the beneficial prognostic impact of negative margins on LRFS and OS. However, the width of negative margins seemed to be not relevant. Notably, adjuvant radiotherapy was not only able to decrease the risk of local failure but also improved OS in a significant manner.

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“…Tan et al represented a remarkable higher rate of DFSP recurrence in MMS using a frozen section as compared to sections embedded in paraffin. This may have occurred due to the changes in frozen dermal tissue, as the residues are difficult to be differentiated from the healthy dermal tissue, particularly following tissue freezing that would change the dermal architecture . Other factors that are affecting the frozen section include the tumor infiltration to the healthy dermis that may be mistakenly misdiagnosed with granulations formed secondary to the biopsies.…”

Section: Discussionmentioning

confidence: 99%

An experience of slow‐Mohs micrographic surgery for the treatment of Dermatofibrosarcoma protuberans: A long‐term cohort study

Asilian

Honarjou

Faghihi

et al. 2020

J of Cosmetic Dermatology

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Background Dermatofibrosarcoma protuberans (DFSP) is a rare dermal mesenchymal tumor known as a low‐grade, slow‐growing malignancy. The local invasion and high rate of recurrence following surgical treatment are the main concerns to plan the best surgical approach of treatment. Aims In the current study, it is aimed to provide an experience of slow‐Mohs surgery for the treatment of patients with DSFP. Patients/Methods Number of 25 patients with the diagnosis of DFSP through histological and immunostaining study was included. The slow‐Mohs was performed by excision of the tumor with margins accounting for 1–2 cm from both the tumor margins and three‐dimensional thickness. The obtained tissue margins were horizontally, and if any of the specimens was not margin‐free, the procedure was repeated. The patients' opinion about the procedure was assessed using Patient‐Observer Scar Assessment Scale (POSAS). Results Number of 25 patients were included and followed for a median of 46.9 months. The median of the area of excision was 35.56 cm2, and the median clinical excision margins were 19 mm (tumor excision margins + thickness of the three‐dimensional excision). The surgery was performed once for 16 (64%), and postoperative skin closure within 5–7 days after the procedure was performed for 19 (76%) patients. None of the patients represented any recurrence. The patients' overall opinion and satisfaction POSAS score accounted for 2.3 ± 1.65 and 1.6 ± 0.59, respectively. Conclusion The findings of the current study are in favor of slow‐Mohs surgery for the management of DFSP, while more extensive studies are strongly recommended for generalization of this procedure.

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A single-institutional review of 68 patients with dermatofibrosarcoma protuberans: wide re-excision after inadequate previous surgery results in a high rate of local control

Cited by 35 publications

References 34 publications

Challenging Dermatofibrosarcoma Protuberans- Surgical Management

Challenging Dermatofibrosarcoma Protuberans- Surgical Management

The Impact of Surgical Margins and Adjuvant Radiotherapy in Patients with Undifferentiated Pleomorphic Sarcomas of the Extremities: A Single-Institutional Analysis of 192 Patients

An experience of slow‐Mohs micrographic surgery for the treatment of Dermatofibrosarcoma protuberans: A long‐term cohort study

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