Wide excision or Mohs micrographic surgery for the treatment of primary dermatofibrosarcoma protuberans.
OBJECTIVE
Dermatofibrosarcoma protuberans (DFSP) is a spindle cell tumor with a high local recurrence rate. Wide excision (WE) has been the standard treatment, but ideal margin width is poorly defined and Mohs micrographic surgery (MMS) has emerged as an alternative procedure. This study examines the use of WE versus MMS for the treatment of primary DFSP at a single institution.


METHODS
Retrospective review of 48 primary DFSP cases treated from 1971 to 2006. Patient demographics, tumor features, surgical modality (WE vs. MMS), final pathology, and clinical outcome were evaluated.


RESULTS
Twenty-eight patients underwent WE versus 20 patients for MMS. Median age was 40 years. Median WE margin width was 2 cm. For MMS, the median number of layers required to clear the tumor was 2. Median maximal defect size was 10 cm for WE versus 9.4 cm for MMS. Advanced closure techniques were required for 18% WE versus 65% MMS (P = 0.001). Median operative time was significantly lower for WE at 77 minutes versus 257 minutes for MMS (P < 0.001). Positive margins were present in 21.4% (6/28) WE versus 0% MMS (P = 0.01). At a median follow-up of 49.9 months for WE and 40.4 months for MMS, local recurrence rates were 3.6% (1/28) and 0%, respectively (P = 1.0).


CONCLUSIONS
From a surgical standpoint, WE was faster than MMS and resulted in a less complex defect/closure. Although positive margin resection was more common with WE, local control was ultimately similar for the 2 surgical modalities. The choice of WE versus MMS should be based on individualized patients/tumor characteristics and institutional expertise in these modalities.
Department of Surgery, McGill University Health Centre, 687 Pine Avenue West, Montreal, Quebec, Canada. ari.meguerditchian@muhc.mcgill.ca
Ari-Nareg
AN
Meguerditchian
Jiping
J
Wang
Bethany
B
Lema
William G
WG
Kraybill
Nathalie C
NC
Zeitouni
John M
JM
Kane
D000293:Adolescent; D000328:Adult; D000368:Aged; D018223:Dermatofibrosarcoma / Q000473:pathology / Q000601:surgery*; D005260:Female; D005629:Frozen Sections / Q000706:statistics & numerical data; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control; D018365:Neoplasm, Residual; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D055815:Young Adult