Recurrence case of rare scalp dermatofibrosarcoma protuberans: Two case reports of a wide radical excision, craniectomy bone involvement followed by cranioplasty and reconstruction

Abstract

Background:Dermatofibrosarcoma protuberans (DFSP) is a rare low-grade sarcoma of the fibroblast originating from the dermal layer of the skin, characterized by a locally aggressive growth and high rate of local recurrence.Case Description:Two patients underwent a wide radical excision of recurrent scalp DFSP which was reconstructed with translational skin flap and split-thickness skin graft. We described above cases several years ago with a local excision of the tumor; recently, they developed local recurrence of DFSP with calvarial involvement. We then performed a wide radical excision, with craniectomy of the cranial defect followed by cranioplasty using titanium mesh, continuing with reconstruction.Conclusion:A successful treatment and management depends on achieving local control and preventing cosmetic and functional deficit; all efforts should be made for complete excision. Postoperative follow-up recommended for highly suspicious cases and annual checkups should be performed up to 5 years after definitive therapy.

Evaluation of Tumor Cell Infiltration to the Skull in Dermatofibrosarcoma Protuberans of the Scalp: Case Report and Literature Review

“…A radical skull resection for recurrent DFSP in the scalp was reported to have shown low clinical local recurrent rates with marginal resection of 20 mm in the cranial bone and w e p e r f o r m e d t h e s a m e d i s t a n t m a r g i n s and analyzed the pathological infiltration to the skull in this case. 10) In our case, no tumor cells infiltrating bone tissues around the skull defect edge were present in detailed pathological analysis. We suppose that the difference in the invasiveness into normal tissues is due to tumor origin and affinity, as is noted in other malignant tumors.…”

“…Clinical data are summarized in Table 1 with our case. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] According to the review, dermal resection with periosteum was an accepted strategy with good local control if the tumor invasion was limited within periosteum. In the four reported DFSP patients whose invasion were limited within periosteum, there were no recurrence in the follow-up periods (range: 4-156 months).…”