Dermatofibrosarcoma protuberans: Role of wide local excision

Raashid Hamid; Aadil Hafeez; Ashraf M. Darzi; Inam Zaroo; Habib Owais; Afrozah Akhter

doi:10.4103/2278-330x.119926

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THE SKILLFUL SCALPEL: Original Article

02 (

); 232-238

doi:

10.4103/2278-330x.119926

Dermatofibrosarcoma protuberans: Role of wide local excision

Raashid Hamid^1,, Aadil Hafeez¹, Ashraf M. Darzi¹, Inam Zaroo¹, Habib Owais¹, Afrozah Akhter¹

1 Department of Plastic Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India

*Corresponding author: Dr. Raashid Hamid. drraashidhamid@gmail.com

Published: 2020-12-31

MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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Abstract

Objectives: The main objective of the present study was to study the outcome of surgical treatment of dermatofibrosarcoma protuberans. Materials and Methods: This study included 45 patients both retrospective and prospective from December 1995 to December 2010. Results: Out of 45 patients, 30 were males and 15 females with the male to female ratio of 2:1. Mean age of presentation was 38.4 + 13.2 years. Commonest mode of presentation was raised firm multinodular lesion with fixity to overlying skin. Site distribution was 42.22% trunk, 57.88% extremities and head and neck. None of the patients had lymph node involvement All patients underwent wide local excision. On histological examination, 8 patients had positive margins. Overall recurrence rate was 22.22%. (please clarify what is the difference between the rate of recurrence following surgery and the overall recurrence rate) Only 2 patients developed metastasis to lungs in the course of their follow‑up. Out of 45 patients, 35 remained recurrence free over a varying period of 5 months to 13 years (mean 68 months). Ten patients developed one or more local recurrences. Average time from initial treatment to recurrence was 32 months. All patients with recurrent tumors were subjected to salvage treatment, i.e., re‑excision. Average recurrence‑free period was 36 + 44 months within a mean follow‑up of 68 months. Conclusion: Because of the potential of local recurrence, therapy for DFSP should be directed toward adequate local excision of the primary lesion. Minimal resection should include a surrounding margin, comprising 3-cm margin of normal skin and removal of underlying deep fascia. Compromising on margins invites higher chances of local recurrence.

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References

Hoffert PW. Dermatofibrosarcoma protuberans: A review of the literature and presentation of three cases. Surgery 1952;31:705-15.
McPeak CJ, Cruz T, Nicastri AD. Dermatofibrosarcoma Protuberans: An analysis of 86 cases-Five with metastasis. Ann Surg 1967;166:803-16.
Angouridakis N, Kafas P, Jerjes W, Triaridis S, Upile T, Karkavelas G, et al. Dermatofibrosarcoma protuberans with fibrosarcomatous transformation of the head and neck. Head and Neck Oncol 2011;3:5.
Pack GT, Tabah EJ. Dermatofibrosarcoma protuberans: A report of 39 cases. AMA Arch Surg 1951;62:391-411.
Eisen RN, Tallini G. Metastatic dermatofibrosarcoma protuberans with fibrosarcomatous change in the absence of local recurrence: A case report of simultaneous occurrence with a malignant giant cell tumour of soft parts. Cancer 1993;15:462-68.
Arican O, Bakaris S, Bulbuloglu E, Ezberci F. Myoid differentiation and EMA expression in fibrosarcomatous dermatofibrosarcoma protuberans. Acta Dermatovenerol Alp Penonica Adriot 2006;15:39-44.
Rowsell AR, Poole MD, Godfrey AM. Dermatofibrosarcoma protuberans: The problems of surgical management. Br J Plast Surg 1986;39:262-4.
McGregor JK. Role of surgery in the management of dermatofibro-sarcoma protuberans. Ann Surg 1961;154:255-8.
Mendenhall WM, Zlotecki RA, Scarborough MT. Dermatofibro-sarcoma protuberans. Cancer 2004;101:2503-8.
Taylor HB, Helwig EB. Dermatofibrosarcoma Protuberans: A study of 115 cases. Cancer 1962;15:717-25.
Brenner W, Schaefler K, Chhabra H, Postel A. Dermatofibrosarcoma Protuberans metastatic to regional lymph node: Report of a case and review. Cancer 1975;36:1897-902.
Jambhekar NA, Chinoy RC. Dertmatofibrosarcoma protuberans-Experience at a cancer hospital in India. Indian J Cancer 88;25:94-103.
Burkhardt BR, Soule EH, Winkelmann RK, Ivins JC. Dermatofibrosarcoma protuberans: Study of fifty six cases. Am J Surg 1966;111:638-44.
Roses DF, Valensi Q, LaTrenta G, Harris MN. Surgical treatment of Dermatofibrosarcoma Protuberans. Surg Gynecol Obstet 1986;162:449-52.
Phelan JT, Juardo J. Dermatofibrosarcoma Protuberans. Am J Surg 1963;106:943-8.
Kransdorf MJ, Meis-Kindblom JM. Dermatofibrosarcoma protuberans: Radiologic appearance. Am J Radiol 1994;163:391-4.
Lindner NJ, Scarborough MT, Powell GJ, Spanier S, Enneking WF. Revision surgery in dermatofibrosarcoma protuberans of the trunk and extremities. Eur J Surg Oncol 1999;25:392-7.
Rutgers EJ, Kroon BB, Albus-Lutter CE, Gortzak E: Dermatofibrosarcoma protuberans: Treatment and prognosis. Eur J Surg Oncol 1992;18:241-8.
Cai H, Wang Y, Wu J, Shi Y. Dermatofibrosarcoma protuberans: Clinical diagnoses and treatment results of 260 cases in China. J Surg Oncol 2012;105:142-8.
Farma JM, Ammori JB, Zager JS, Marzban SS, Bui MM, Bichakjian CK, et al. Dermatofibrosarcoma Protuberans: How wide should we resect? Ann Surg Oncol 2010;17:2112-7.

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[1] Hoffert PW. Dermatofibrosarcoma protuberans: A review of the literature and presentation of three cases. Surgery 1952;31:705-15.

[2] McPeak CJ, Cruz T, Nicastri AD. Dermatofibrosarcoma Protuberans: An analysis of 86 cases-Five with metastasis. Ann Surg 1967;166:803-16.

[3] Angouridakis N, Kafas P, Jerjes W, Triaridis S, Upile T, Karkavelas G, et al. Dermatofibrosarcoma protuberans with fibrosarcomatous transformation of the head and neck. Head and Neck Oncol 2011;3:5.

[4] Pack GT, Tabah EJ. Dermatofibrosarcoma protuberans: A report of 39 cases. AMA Arch Surg 1951;62:391-411.

[5] Eisen RN, Tallini G. Metastatic dermatofibrosarcoma protuberans with fibrosarcomatous change in the absence of local recurrence: A case report of simultaneous occurrence with a malignant giant cell tumour of soft parts. Cancer 1993;15:462-68.

[6] Arican O, Bakaris S, Bulbuloglu E, Ezberci F. Myoid differentiation and EMA expression in fibrosarcomatous dermatofibrosarcoma protuberans. Acta Dermatovenerol Alp Penonica Adriot 2006;15:39-44.

[7] Rowsell AR, Poole MD, Godfrey AM. Dermatofibrosarcoma protuberans: The problems of surgical management. Br J Plast Surg 1986;39:262-4.

[8] McGregor JK. Role of surgery in the management of dermatofibro-sarcoma protuberans. Ann Surg 1961;154:255-8.

[9] Mendenhall WM, Zlotecki RA, Scarborough MT. Dermatofibro-sarcoma protuberans. Cancer 2004;101:2503-8.

[10] Taylor HB, Helwig EB. Dermatofibrosarcoma Protuberans: A study of 115 cases. Cancer 1962;15:717-25.

[11] Brenner W, Schaefler K, Chhabra H, Postel A. Dermatofibrosarcoma Protuberans metastatic to regional lymph node: Report of a case and review. Cancer 1975;36:1897-902.

[12] Jambhekar NA, Chinoy RC. Dertmatofibrosarcoma protuberans-Experience at a cancer hospital in India. Indian J Cancer 88;25:94-103.

[13] Burkhardt BR, Soule EH, Winkelmann RK, Ivins JC. Dermatofibrosarcoma protuberans: Study of fifty six cases. Am J Surg 1966;111:638-44.

[14] Roses DF, Valensi Q, LaTrenta G, Harris MN. Surgical treatment of Dermatofibrosarcoma Protuberans. Surg Gynecol Obstet 1986;162:449-52.

[15] Phelan JT, Juardo J. Dermatofibrosarcoma Protuberans. Am J Surg 1963;106:943-8.

[16] Kransdorf MJ, Meis-Kindblom JM. Dermatofibrosarcoma protuberans: Radiologic appearance. Am J Radiol 1994;163:391-4.

[17] Lindner NJ, Scarborough MT, Powell GJ, Spanier S, Enneking WF. Revision surgery in dermatofibrosarcoma protuberans of the trunk and extremities. Eur J Surg Oncol 1999;25:392-7.

[18] Rutgers EJ, Kroon BB, Albus-Lutter CE, Gortzak E: Dermatofibrosarcoma protuberans: Treatment and prognosis. Eur J Surg Oncol 1992;18:241-8.

[19] Cai H, Wang Y, Wu J, Shi Y. Dermatofibrosarcoma protuberans: Clinical diagnoses and treatment results of 260 cases in China. J Surg Oncol 2012;105:142-8.

[20] Farma JM, Ammori JB, Zager JS, Marzban SS, Bui MM, Bichakjian CK, et al. Dermatofibrosarcoma Protuberans: How wide should we resect? Ann Surg Oncol 2010;17:2112-7.

Dermatofibrosarcoma protuberans: Role of wide local excision

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