title: Dermatofibrosarcoma protuberans: margins reduction using slow-Mohs micrographic surgery. Experience with 35 patients.
abstract: BACKGROUND
  Dermatofibrosarcoma protuberans (DFSP) is a potentially malignant dermal mesenchymal tumour with a high risk of local recurrence. DFSP presents a sprawling appearance whose complete excision requires important margins. DFSP was initially resected with a 5cm excision margins, and more recently 3cm then 2cm margins were recommended. Mohs micrographic surgery (MMS) helps reduce these margins thanks to a 3-dimensional excision around the tumour, which is analysed in its entirety. We used the modified MMS called slow-MMS and tried every time it was possible to perform direct closure.
  
  
  METHODS
  Thirty-five patients presenting a DFSP between 2004 and 2013 within the Plastic Surgery unit at Claudius Regaud Institute were included in this retrospective study. The patients were treated with slow-MMS using paraffin-embedded sections.
  
  
  RESULTS
  One surgery was necessary for 72% of patients. For 17%, we had to perform a second surgery, and for 11% a third one. Our median clinical excision margins was 17mm (range 9.0:30.0). After a median follow-up of 46 months (range 35.2:60.2), we didn't observe any recurrence. Only one case required a local flap; for the others, the loss of substance was resolved with a direct closure.
  
  
  CONCLUSIONS
  Slow-MMS enabled a local control of the margins without recurrence at 46 months in our series. Besides, it helps performing smaller margins than wide excision and thus preserving the tissues. In our opinion, this is the treatment of choice regarding DFSP for which tissue sparing is essential. It seems particularly appropriate near functional areas or on the face.
authors.affiliation: Service de chirurgie plastique et reconstructrice, 1, avenue Jean-Poulhès, 31059 Toulouse, France; Institut Claudius-Regaud, 20, rue de Pont-St-Pierre, 31000 Toulouse, France; Service d'anatomie pathologique et d'histologie-cytologie, UF d'histologie-cytologie, hôpital de Rangueil, 1, avenue Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France. Electronic address: Benoitchaput31@gmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Chaput
authors.affiliation: Institut Claudius-Regaud, 20, rue de Pont-St-Pierre, 31000 Toulouse, France.
authors.forename: T
authors.initials: T
authors.lastname: Filleron
authors.affiliation: Institut Claudius-Regaud, 20, rue de Pont-St-Pierre, 31000 Toulouse, France.
authors.forename: S
authors.initials: S
authors.lastname: Le Guellec
authors.affiliation: Service de chirurgie plastique et reconstructrice, 1, avenue Jean-Poulhès, 31059 Toulouse, France; Institut Claudius-Regaud, 20, rue de Pont-St-Pierre, 31000 Toulouse, France.
authors.forename: T
authors.initials: T
authors.lastname: Meresse
authors.affiliation: Service d'anatomie pathologique et d'histologie-cytologie, UF d'histologie-cytologie, hôpital de Rangueil, 1, avenue Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
authors.forename: M
authors.initials: M
authors.lastname: Courtade-Saïdi
authors.affiliation: Service de chirurgie plastique et reconstructrice, 1, avenue Jean-Poulhès, 31059 Toulouse, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Grolleau
authors.affiliation: Institut Claudius-Regaud, 20, rue de Pont-St-Pierre, 31000 Toulouse, France.
authors.forename: C
authors.initials: C
authors.lastname: Chevreau
authors.affiliation: Service de chirurgie plastique et reconstructrice, 1, avenue Jean-Poulhès, 31059 Toulouse, France; Institut Claudius-Regaud, 20, rue de Pont-St-Pierre, 31000 Toulouse, France.
authors.forename: I
authors.initials: I
authors.lastname: Garrido
authors.affiliation: Service de chirurgie plastique et reconstructrice, 1, avenue Jean-Poulhès, 31059 Toulouse, France; Institut Claudius-Regaud, 20, rue de Pont-St-Pierre, 31000 Toulouse, France.
authors.forename: D
authors.initials: D
authors.lastname: Gangloff
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018223:Dermatofibrosarcoma / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery / Q000379:methods*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D055815:Young Adult
keywords: Chirurgie micrographique slow-Mohs; Dermatofibrosarcoma protuberans; Dermatofibrosarcome; Margins reduction; Paraffin-embedded sections; Slow-Mohs micrographic surgery; coupes en paraffine