Multidisciplinary approach to the management of dermatofibrosarcoma protuberans

Buck, Donald W.; Kim, John Y.S.; Alam, Murad; Rawlani, Vinay; Johnson, Sarah A.; Connor, Caitlin M.; Dumanian, Gregory A.; Wayne, Jeffrey D.

doi:10.1016/j.jaad.2012.01.039

Cited by 32 publications

(26 citation statements)

References 16 publications

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“…6,7 This technique has been employed for different types of NMSC but the literature is sparse on using this technique for highrisk squamous cell carcinoma (SCC) or morpheaform basal cell carcinoma (BCC), none of which, to our knowledge, have been previously reported in the dermatology literature. [6][7][8] Our three cases of complex NMSC provide further data supporting the use of MMS for peripheral margin control even if the patient will require central tumor extirpation and defect reconstruction at a later date in the operating room. Peripheral margin control can be achieved in the office under local anesthesia and reduce the time the patient is in the operating room under general anesthesia, in addition to providing superior rates of tumor clearance via comprehensive, longitudinal en face sectioning.…”

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confidence: 60%

Mohs Micrographic Surgery Peripheral Margin Control Prior to En Bloc Tumor Resection: A Report of Three Cases

Bernstein

Giddings

Khorasani³

2018

J of Skin

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An otherwise healthy, 58-year-old male presented with a long standing morpheaform basal cell carcinoma of the left midface, involving lip, nose and cheek (Figure 1). Pathology was remarkable for a deeply infiltrating tumor including perineural and maxillary bone invasion. Multidisciplinary care was coordinated with facial plastic surgery. Two stages of Mohs micrographic surgery (MMS) were needed ABSTRACT Background. Mohs micrographic surgery (MMS) is an important part of non-melanoma skin cancer (NMSC) management but may even be useful for tumors that cannot be cleared in an office setting. There are sparse reports of MMS for peripheral margin control in the dermatology literature but various techniques have been reported.

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confidence: 60%

Mohs Micrographic Surgery Peripheral Margin Control Prior to En Bloc Tumor Resection: A Report of Three Cases

Bernstein

Giddings

Khorasani³

2018

J of Skin

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“…Although it represents less than 0.1% of malignant tumors, it is considered the most common skin sarcoma [2,3]. In the United States, the annual incidence of DFSPs is about 4.5 cases per million individuals [3].…”

Section: Introductionmentioning

confidence: 99%

“…Difficulties in the management of scalp DFSP stem from the high propensity of its recurrence which is explained by tentaclelike extensions of malignant cells that microscopically invade the surrounding dermis and subcutis horizontally and/or the underlying structures vertically, making it difficult to achieve clean surgical margins and to determine the tumor boundaries histopathologically [2,4]. Traditionally, wide local excision and/or Mohs micrographic surgery (MMS) have been used for the management of DFSP and are currently recommended by the National Comprehensive Cancer Network (NCCN) [2].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Traditionally, wide local excision and/or Mohs micrographic surgery (MMS) have been used for the management of DFSP and are currently recommended by the National Comprehensive Cancer Network (NCCN) [2]. However, there are conflicting opinions regarding the safety and efficacy in terms of local recurrence, tissue preservation and subsequent reconstruction outcomes [2]. Numerous studies have demonstrated multi-staged surgical excision and reconstruction for the management of scalp DFSPs reporting unfavorable outcomes in terms of local recurrences and/or wound complications [4,6,7].…”

Section: Introductionmentioning

confidence: 99%

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http://www.avensonline.org/fulltextarticles/JSUR-2332-4139-S1-0001.html

2015

J Surg

521

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Outcome after surgical treatment of dermatofibrosarcoma protuberans: Is clinical follow‐up always indicated?

Veld

Coevorden

Grünhagen

et al. 2019

Cancer

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BACKGROUND: Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue sarcoma for which clinical examination up to 10 years is recommended. The objective of this study was to identify prognostic factors for recurrences and metastases that can be used to evaluate the validity of follow-up schedules after treatment for DFSP. METHODS: Patients with DFSP who received treatment between 1991 and 2016 at 3 tertiary centers were included. Cox regression analyses were conducted to identify variables associated with the primary endpoints. RESULTS: In total 357 patients were included, with a median age of 38 years (age range, 2-87 years) and a median follow-up of 60 months (interquartile range, 24-115 months). Eighty-one patients developed recurrent disease (22.7%), and the median time to recurrence was 55.5 months (interquartile range, 20-90 months). Of these, 50 tumors (61.7%) were identified by patient self-examination, whereas 3 recurrences (3.7%) were identified at clinical surveillance. For the remaining 28 tumors, no information was available on how the recurrences were identified (34.6%). Fibrosarcomatous change (hazard ratio, 21.865; P < .001), and positive resection margins (hazard ratio, 14.645; P < .001), were independent prognostic factors for recurrence. Metastases occurred in 4 patients (1.1%). All tumors were identified by imaging after patients presented with symptomatic metastases. Fibrosarcomatous change (P < .001) and tumor size >5 cm (P = .014) were associated with the development of metastases. CONCLUSIONS: Disease recurrence after resection of DFSP remains a significant issue, whereas metastases are uncommon. The majority of recurrences are identified by patient self-examination. Consideration should be given to individualized follow-up schedules based on risk factors for recurrences and metastases. Cancer 2019;125:735-741.

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Multidisciplinary approach to the management of dermatofibrosarcoma protuberans

Cited by 32 publications

References 16 publications

Mohs Micrographic Surgery Peripheral Margin Control Prior to En Bloc Tumor Resection: A Report of Three Cases

Mohs Micrographic Surgery Peripheral Margin Control Prior to En Bloc Tumor Resection: A Report of Three Cases

http://www.avensonline.org/fulltextarticles/JSUR-2332-4139-S1-0001.html

Outcome after surgical treatment of dermatofibrosarcoma protuberans: Is clinical follow‐up always indicated?

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