Operative Management of Dermatofibrosarcoma Protuberans of the Breast

Kinney, Melissa H.; Knox, Sally M.

doi:10.1080/08998280.2016.11929450

Cited by 7 publications

(5 citation statements)

References 19 publications

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“…Interestingly for DFSP of the breast, there are no case reports that describe use of MMS for resection, very few case reports that describe reconstruction and its complications following resection, and no studies that compare complications between primary closure and reconstruction [ 8 ]. In addition to primary closure, reconstruction techniques cited in the literature include pedicled latissimus dorsi flap, rotation flap, reverse abdominoplasty, pectoralis flap, and reduction mammoplasty to provide wound coverage and to preserve breast shape [ 25 - 30 ]. We found no complications in our MMS and primary closure cohort but encountered complications requiring intervention with WLE and skin grafts, implant, and rotational flap reconstructions.…”

Section: Discussionmentioning

confidence: 99%

Wide local excision, Mohs micrographic surgery, and reconstructive options for treatment of dermatofibrosarcoma protuberans of the breast: A retrospective case series from Mayo Clinic

et al. 2023

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Background Dermatofibrosarcoma protuberans (DFSP) of the breast is a dermal fibroblastic neoplasm requiring wide excisional margins due to recurrence rates ranging from 26 to 60%. The current literature on reconstructive options and utility of Mohs micrographic surgery for DFSP of the breast is scarce. We describe surgical management of DFSP of the breast at our institution with the largest case series reported to date. Methods A retrospective review was performed of women who underwent surgery for DFSP of the breast at our institution between 1990 and 2019. Continuous data was summarized using mean, median, and range; categorical data was summarized with frequency count and percentage. Preoperative lesion size and postoperative defect size were evaluated using 2-sided Fisher exact test, and p-values < 0.05 were considered statistically significant. Results Nine patients underwent wide local excision (WLE) with reconstruction including pedicled latissimus dorsi flaps (n = 2), local flap advancement (n = 2), mastectomy with implant (n = 1), oncoplastic breast reduction (n = 1), and skin grafts (n = 3). Nine underwent Mohs micrographic surgery (MMS) with complex primary closure. Mean postoperative maximum wound defect size for WLE was 10.8 cm versus 7.0 cm for MMS with no statistical significance (p = 0.77). Mean preoperative maximum lesion size for WLE was 6.4 cm versus 3.3 cm for MMS with no statistical significance (p = 0.07). Complications with WLE included wound dehiscence in three patients and seroma in one patient. No complications were reported with MMS and primary closure. Recurrence was reported in one WLE patient, which was successfully detected despite flap coverage and resected without complications. Median follow-up for the patients without recurrence was 5.0 years, with two patients in MMS cohort lost to follow-up. Five-year overall survival was 100%. Conclusions MMS and WLE are both viable surgical options for managing DFSP of the breast. MMS could potentially minimize reconstructive needs due to smaller average defect size and result in fewer complications but may also result in asymmetry. Immediate flap reconstruction, especially in larger defects, can achieve excellent aesthetic outcomes for patients with DFSP of the breast without compromising detection of disease recurrence.

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Section: Discussionmentioning

confidence: 99%

Wide local excision, Mohs micrographic surgery, and reconstructive options for treatment of dermatofibrosarcoma protuberans of the breast: A retrospective case series from Mayo Clinic

et al. 2023

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“…There are no recommended excision margins specifically for DFSP of the breast with most previous cases aiming for resection margins of 2-4 cm [9][10][11] and even up to 5 cm [12]. The National Comprehensive Cancer Network has recommended 2-4-cm resection margins for DFSP but no sub-criteria for DFSP of the breasts have been proposed [13].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Difficulties and Complexities in the Management of Dermatofibrosarcoma Protuberans in the Breast: A Case Report and Review of the Literature

Tan³

et al. 2021

Cureus

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Dermatofibrosarcoma protuberans (DFSP) is an extremely rare sarcoma with an incidence between 0.8-5.0 cases per one million persons per year. DFSP accounts for less than 0.1% of all malignancies and approximately 1-6% of all soft tissue sarcomas. Only a few cases of DFSP have been found within the breast tissue. We report a case of DFSP in a 30-year-old female within the left breast. The sarcoma presented as a painless, rubbery, mobile lump that gradually increased in size. It was initially identified on an ultrasound scan and subsequently confirmed with MRI and core biopsy.DFSP is a rare condition and treatment guidelines are not well established. The current recommendation is for surgical excision with 2-cm margins. Mastectomy may be considered in some circumstances. In our case, the aim was for surgical resection with 2-cm margins at both breast tissue and skin, but insufficient margins were taken. The recommendation for re-excision of the inadequate margins was declined. It is uncertain what the implications of this are given the lack of research on DFSP in the breast. Therefore, close surgical surveillance will be imperative. We present this case to highlight the difficulties associated with the diagnosis, treatment, and management of DFSP due to the lack of literature on this disease.

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“…The characteristic imaging feature of DFSP in the breast are not well-defined [ 19 ]. The screening of breast tumor usually includes mammography, US, computed tomography, and MRI.…”

Section: Discussionmentioning

confidence: 99%