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Dermatofibromasarcoma Protuberans: A Review of Our Management and Surgical Technique
Stephenie Poris, Gary Pennington, Lawrence Cervino
Summa Health
2020-02-14
Presenter: Stephenie Poris MD
Affidavit:
Douglas Wagner MD
Director Name: Douglas Wagner
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Dermatofibromsarcoma protuberans is a rare, low-grade sarcoma extending from the dermis into the subcutis. It carries an incidence rate in the United States of 4.2 to 4.5 cases per million persons per year. Within the plastic surgery community, misdiagnosis, incomplete excision and recurrence occur frequently. The tumor itself rarely metastasizes, but the local management can be difficult due to the highly irregular shapes and finger-like extensions of the tumor.
In our DFSP population the surgeon emphasizes management strategies depending on size and location of the tumor, and consideration is given to cosmesis to dictate the most appropriate surgical approach. Within our practice, all patients were referred after biopsy for definitive surgical intervention. It is our standard to obtain the largest margin possible (1-5 cm) with respect to cosmetically sensitive areas and await final circumferential histologic analysis before reconstruction occurs.
It is not uncommon in our practice to undergo multiple surgeries to achieve negative margins given the stellate nature of DFSP growth. Review of our DFSP patient population has shown that most DFSP patients await final reconstruction until pathology has confirmed negative margins. Because DFSP has a tendency to occur almost anywhere, location and size are significant concerns for reconstruction. We use the reconstructive ladder to address most defects and for any immediate reconstructions, STSG is usually preferred given the possibility of margin positivity. The reviewing pathologist should be familiar with DFSP and provide certainty of margins prior to reconstruction, as local recurrence can range from 10-60%.
