title: Dermatofibrosarcoma Protuberans: The role of tissue expansion in reconstructive surgery of the scalp.
abstract: BACKGROUND
  Dermatofibrosarcoma Protuberans is an uncommon tumour, making up less than 0.1% of all malignancies. With regards to soft tissue tumours; this pathology is thought to make up less than 2% of the sum total. Traditionally treatment has been wide local excision, with or without adjuvant radiotherapy.
  
  
  METHODS
  We present a case of a 42 year old man referred by his GP with a lump on the right parietal region of the scalp. An USS done by his GP revealed a complex hypoechoic cystic mass, some 2cm×1cm×2cm. Excision biopsy was performed and on review of the pathology it was noted that the lesion was a Dermatofibrosarcoma Protuberans. Due to the relatively low grade of this sarcoma, it was decided to treat with wide local excision with 2-4cm margins. The expected residual scalp defect would be difficult to close with local flaps. To facilitate closure tissue expansion was undertaken for 6 weeks prior to definitive surgery.
  
  
  CONCLUSIONS
  With regards to tumours of the head and neck, use of a tissue expander has been recommended to improve cosmetic outcomes following respective surgery with wide margins. Ultimately the timing of tissue expansion i.e. before/after resection of the tumour, must weight the risk of delayed resective surgery on prognosis against the benefits of this reconstructive technique.
  
  
  CONCLUSIONS
  Head and neck tumours requiring careful reconstruction may benefit from tissue expansion to provide adequate volumes of matching soft tissue, as shown in this case.
authors.affiliation: Gold Coast University Hospital, 1 Hospital Boulevard, Southport 4215, Australia. Electronic address: richard.maguire@my.jcu.edu.au.
authors.forename: Richard
authors.initials: R
authors.lastname: Maguire
authors.affiliation: Gold Coast University Hospital, 1 Hospital Boulevard, Southport 4215, Australia.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Nikolorakos
authors.affiliation: Gold Coast University Hospital, 1 Hospital Boulevard, Southport 4215, Australia.
authors.forename: Alfred
authors.initials: A
authors.lastname: Lam
keywords: Dermatofibrosarcoma Protuberans; ENT; Maxillofacial; Tissue expander