Dermatofibrosarcoma protuberans: 35 patients treated with Mohs micrographic surgery using paraffin sections

Abstract

We present 35 DFSP patients, none of whom showed persistent tumour after treatment with 'slow' MMS using paraffin sections. We advocate MMS as the treatment of choice for DFSP, especially for tumours over the head and neck region where tissue conservation is particularly important.

Three-dimensional histology for dermatofibrosarcoma protuberans: Case series and surgical technique

“…15 The main aim of MMS in DFSP is to minimize surgical margins, resulting in less complicated reconstructions with smaller postsurgical defects, without jeopardizing the oncological resection. 6,11,13,15,20 The oncological effectiveness of this technique has been already extensively proven. Paradisi et al 15 in their meta-analysis of 463 patients with DFSP treated with MMS, reported recurrence in only 6 cases, resulting in a 1.3% rate.…”

“…This low rate, which has been replicated in multiple series, confirms that the treatment of choice for DFSP is MMS. 3,6,10,13,14 The most important aspects of this study are the surgical technique and histologic analysis performed. First, we strongly recommend 3D histology surgery for tumor excision with lateral margins of 1 or 1.5 cm and fascia extirpation.…”

“…Currently the best surgical treatment of DFSP is that which allows complete analysis of the piece, sparing surrounding tissue, while still achieving clear margins. [12][13][14][15] The concept of histologic study of all margins of any given tumor was first introduced in 1941 by the American surgeon Frederic Edward Mohs, who originally used chemosurgery. 14 After its original description, several schools modified both the name and the technique itself.…”

Nodular fasciitis complicating a staged surgical excision of dermatofibrosarcoma protuberans

“…Options for excision include Mohs micrographic surgery with horizontal frozen sections, modified Mohs technique with an analysis of the final margin with permanent sections, and wide local excision with 2 to 4 cm margins including muscle fascia [3]. A case series of 35 patients with DFSP treated with a modified Mohs technique with paraffin tissue processing found no evidence of tumor recurrence with a median follow-up time of 30 months [16]. Our technique, while technically not Mohs surgery because the surgery and pathology were performed by different physicians, mimics "slow Mohs" in which both are performed by the same physician.…”

Les chirurgies micrographiques : techniques, indications et applications pratiques en cabinet

“…Le taux de récidive à cinq ans est évalué à 1,3 % après une chirurgie de Mohs contre 20 % en cas d'exérèse à 3 cm [21]. Plusieurs séries de patients traités par la technique de slow-Mohs rapportent de très faibles taux de récidive (< 2 %) avec un recul de 2,5 à huit ans [22][23][24][25][26].…”