Mohs micrographic surgery in dermatofibrosarcoma protuberans: Rate and risk factors for recurrence in a prospective cohort study from the Spanish Registry of Mohs Surgery (REGESMOHS) and review of the literature

Abstract

Characterization of patients, surgery procedures and the risk factors for dermatofibrosarcoma protuberans (DFSP) recurrences is poorly defined. In this study, we aimed to describe the demographics, tumor characteristics and interventions of DFSP treated with Mohs micrographic surgery (MSS) to determine the rate and risk factors for recurrence. Data were collected from REGESMOHS, a nationwide prospective cohort study of patients treated with MMS in Spain. From July 2013 to February 2020, 163 patients with DFSP who underwent MMS were included. DFSP was mostly located on trunk and extremities. Recurrent tumors had deeper tumor invasion and required higher number of MMS stages. Paraffin MMS was the most frequently used technique. Overall recurrence rate was 0.97 cases/100 person‐years (95% IC = 0.36–2.57). No differences were found in epidemiological, tumor, surgery characteristics or surgical technique (frozen or paraffin MMS [p = 0.6641]) in terms of recurrence. Median follow‐up time was 28.6 months with 414 patient‐years of follow‐up. In conclusion, we found an overall low recurrence rate of DFSP treated with MMS. None of the studied risk factors, including MMS techniques, was associated with higher risk for recurrence.

A 73-Year-Old Female Diagnosed With Dermatofibrosarcoma Protuberans in the Primary Care Setting: A Case Report and Literature Review of Misdiagnosed Cases

“…Over several months to many years, the early lesions slowly enlarge to form protuberant, indurated, reddish-blue to violaceous nodules. DFSPs range in size from 0.5 cm to > 10 cm and typically present on the trunk (40-50%), followed by proximal extremities (30-40%) and head and neck (10-15%) [2][3][4]6].…”

“…A dermoscopy is a valuable tool in tumor recognition and findings may prompt neoplasm diagnosis [5]. Although DFSP has a relatively good prognosis, it has a high propensity for recurrence and a rare potential for distant metastasis [2][3][4]. Standard treatment for DFSP involves complete surgical resection by either wide local excision (WLE) with margins or Mohs micrographic surgery (MMS) [2,7].…”

Surgical management of dermatofibrosarcoma protuberans

“…Although there are some benefits to slow‐Mohs, it is more expensive, time‐consuming, and may require patients to return for multiple surgeries, all of which limit the practicality of widespread use of this technique. Additionally, a recent analysis of patients with DFSP, who were included in the REGESMOHS (Spanish Registry of Mohs Surgery) trial from Spain, showed no difference in local recurrence between tumors evaluated by frozen section and those analyzed via paraffin section 42 . Table 2 summarizes selected series of MMS.…”

“…Additionally, a recent analysis of patients with DFSP, who were included in the REGESMOHS (Spanish Registry of Mohs Surgery) trial from Spain, showed no difference in local recurrence between tumors evaluated by frozen section and those analyzed via paraffin section. 42 Table 2 summarizes selected series of MMS.…”

Dermatofibrosarcoma protuberans：clinical and pathological analysis of Asian samples from one center experience.

“…Medical records retrospect showing the 2 of 4 recurrence cases in this study owing to the positive margin while other 2 recurrence cases relapsed in 6 years later after rst surgery. According to the previous studies, Mohs micrographic surgery (MSS) associated with low recurrence rate of DFSP than WLE(15,20). Matthew T Houdek et al(21)indicated no statistical signi cance in oncologic outcomes comparing MMS with WLE in head and neck sites.…”