Dermatofibrosarcoma Protuberans of the Forehead and Scalp with Involvement of the Outer Calvarial Plate: Multistaged Repair with the Use of Skin Expanders
Abstract:Multistaged repair of the face is a viable alternative surgical approach to preserve facial contours and minimize distortion in the treatment of DFSP. This case illustrates the degree of complexity that the treatment of DFSP may involve.
“…This is a reassuring finding considering that 50% of DFSP recurrences are observed within the first year and 80% within the first 3 years. 4 The low recurrence rates demonstrated with MMS in our patient population and in previous reports compare favorably to those of traditional surgery with reported marginal recurrence rates of 20% to 50%. 4,9 DFSP is known to have extensive subclinical spread with 3-cm surgical margins yielding recurrence rates of up to 20% 9 and reports of greater than 10 cm of lesion spread beyond the clinical border.…”
“…4 The low recurrence rates demonstrated with MMS in our patient population and in previous reports compare favorably to those of traditional surgery with reported marginal recurrence rates of 20% to 50%. 4,9 DFSP is known to have extensive subclinical spread with 3-cm surgical margins yielding recurrence rates of up to 20% 9 and reports of greater than 10 cm of lesion spread beyond the clinical border. 7 Ratner and associates 7 reported that standard wide excision with a width of 1 cm would leave residual tumor in 70.7% of tumors; 2 cm would leave tumor in 39.7%; 3 cm would leave tumor in 15.5%; and 5 cm would leave tumor in 5.2%.…”
Collectively, our data on PDSCC, DFSP, MAC, and EMPD, combined with other studies in the literature, show that MMS is the most effective therapy for these rare aggressive cutaneous malignancies.
“…This is a reassuring finding considering that 50% of DFSP recurrences are observed within the first year and 80% within the first 3 years. 4 The low recurrence rates demonstrated with MMS in our patient population and in previous reports compare favorably to those of traditional surgery with reported marginal recurrence rates of 20% to 50%. 4,9 DFSP is known to have extensive subclinical spread with 3-cm surgical margins yielding recurrence rates of up to 20% 9 and reports of greater than 10 cm of lesion spread beyond the clinical border.…”
“…4 The low recurrence rates demonstrated with MMS in our patient population and in previous reports compare favorably to those of traditional surgery with reported marginal recurrence rates of 20% to 50%. 4,9 DFSP is known to have extensive subclinical spread with 3-cm surgical margins yielding recurrence rates of up to 20% 9 and reports of greater than 10 cm of lesion spread beyond the clinical border. 7 Ratner and associates 7 reported that standard wide excision with a width of 1 cm would leave residual tumor in 70.7% of tumors; 2 cm would leave tumor in 39.7%; 3 cm would leave tumor in 15.5%; and 5 cm would leave tumor in 5.2%.…”
Collectively, our data on PDSCC, DFSP, MAC, and EMPD, combined with other studies in the literature, show that MMS is the most effective therapy for these rare aggressive cutaneous malignancies.
“…Most cases in the literature and at RPCI required complex closure, including mucocutaneous flaps, free flaps, and pedicle flaps with or without the use of split‐thickness skin grafts. For restoration of the patient's normal hairline, some authors have suggested the possibility of using scalp expansion 19,20 . Dermatologic surgeons must be prepared to undertake advanced reconstruction of their defects with the help of a multidisciplinary team.…”
Mohs micrographic surgery or a modified version may be the best treatment option for scalp dermatofibrosarcoma protuberans to ensure complete removal of tumor and minimize recurrence. Surgeons should be prepared for advanced reconstruction following tumor removal.
“…DFSP on the scalp can cause erosion of the bone and even fatal invasion of the brain. [5][6][7]17,18 For these patients, an invasive surgical procedure will be required with removal of the affected periosteum and calvarial plate. Closure of these defects can be challenging and necessitates a multidisciplinary approach by the Mohs surgeon, plastic surgeons, and neurosurgeons.…”
Section: General Aspects Of Dermatofibrosarcoma Protuberansmentioning
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.