Dermatofibrosarcoma protruberans of the scalp treated by radical excision, immediate cranioplasty, and free groin flap

Abstract

The authors describe a case of dermatofibrosarcoma protruberans of the frontal region in a young girl. The condition was treated by radical excision of the scalp, frontal bone, and sinuses, and immediate reconstruction with an acrylic cranioplasty and microsurgical transfer of a free groin flap. Pathological examination revealed the margins of the excised specimen were clear of tumor. The initial flap failed, but a second graft was immediately transferred successfully, with a good cosmetic result.

Reconstruction of a Scalp and Skull Defect with Free Latissimus Dorsi Myocutaneous Flap following Dermatofibrosarcoma Protuberans

“…Dermatofibrosarcoma protuberans is classified as a fibrohistocytic tumour of intermediate-grade malignancy. 4 Dermatofibrosarcoma protuberans is reported to exhibit frequent local recurrence [1][2][3] but to rarely exhibit metastasis. 4 Simple excision of the tumour was initially performed on this patient, but frequent local recurrence Figure 1 Artificial dura mater (arrow) was exposed due to the skin defect following surgery.…”

“…1,2 Dermatofibrosarcoma protuberans tends to occur on the trunk and proximal region of the extremities while it rarely develops on the head. It frequently recurs locally due to incomplete excision [1][2][3] but rarely metastases. 4 We treated a patient who had undergone simple excision alone as the initial treatment of dermatofibrosarcoma protuberans on the scalp.…”

Dermatofibrosarcoma protuberans at an uncommon site

“…The treatment of choice is wide surgical excision ensuring adequate margins of 3-5 cm, followed by immediate reconstruction. [ 8 ] Radiotherapy and chemotherapy have been tried with limited success . The significant prognostic factor for relapse is considered to be the extent of the initial resection as close margins that is less than 2 cm shows a statistically significant positive correlation with recurrence.…”

Unusual presentation of dermatofibrosarcoma protuberans

“…4 Most of the authors recommend, as best therapeutic choice, a single staged radical excision of scalp and underlying bone with immediate cranioplasty and free musculo-cutaneous flap coverage of skin defect. 7,8 In fact, the ability to provide single stage reconstructions of large scalp defects and underlying cranium represents a considerable advance of contemporary reconstructive plastic surgery.…”