title: A Comparison of Mohs Micrographic Surgery and Wide Local Excision for Treatment of Dermatofibrosarcoma Protuberans With Long-Term Follow-up: The Mayo Clinic Experience.
abstract: BACKGROUND
  Dermatofibrosarcoma protuberans (DFSP) is a soft tissue tumor with slow infiltrative growth and local recurrence if inadequately excised.
  
  
  OBJECTIVE
  To compare long-term outcomes after Mohs micrographic surgery (MMS) and wide local excision (WLE).
  
  
  METHODS
  Records of patients with DFSP surgically treated with WLE or MMS from January 1955 through March 2012 were retrospectively reviewed.
  
  
  RESULTS
  Mean follow-up for patients treated with MMS (n = 67) and WLE (n = 91) was 4.8 and 5.7 years, respectively. Twenty-eight patients (30.8%) with WLE had recurrence (mean, 4.4 years), whereas only 2 (3.0%) with MMS had recurrence (1.0 and 2.6 years). Recurrence-free survival rates at 1, 5, 10, and 15 years were significantly higher with MMS (p < .001). Mean preoperative lesion sizes were similar (5-6 cm) between the 2 groups, whereas mean (standard deviation) postoperative defect sizes were 10.7 (4.3) cm and 8.8 (5.5) cm for WLE and MMS, respectively (p = .004). Primary closure was used for 73% of MMS cases, whereas WLE more commonly used flaps, grafts, or other closures (52%). Two Mohs layers typically were required for margin control.
  
  
  CONCLUSIONS
  Surgical excision with meticulous histologic evaluation of all surgical margins is needed for DFSP treatment to achieve long-term high cure rates and low morbidity.
authors.affiliation: *Department of Dermatology, Mayo Clinic, Rochester, Minnesota; †Mayo Medical School, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Garrett C
authors.initials: GC
authors.lastname: Lowe
authors.forename: Oluwakemi
authors.initials: O
authors.lastname: Onajin
authors.forename: Christian L
authors.initials: CL
authors.lastname: Baum
authors.forename: Clark C
authors.initials: CC
authors.lastname: Otley
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Arpey
authors.forename: Randall K
authors.initials: RK
authors.lastname: Roenigk
authors.forename: Jerry D
authors.initials: JD
authors.lastname: Brewer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D018223:Dermatofibrosarcoma / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D018365:Neoplasm, Residual; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D016038:Skin Transplantation; D013524:Surgical Flaps; D013997:Time Factors; D047368:Tumor Burden; D058106:Wound Closure Techniques; D055815:Young Adult