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Badhey AK, Tikhtman R, Tang AL. Management of dermatofibrosarcoma protuberans. Curr Opin Otolaryngol Head Neck Surg 2021; 29:278-282. [PMID: 33993132 DOI: 10.1097/moo.0000000000000721] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Provide an up to date review of the diagnosis, workup and treatment of dermatofibrosarcoma protuberans (DFSP). DFSP can be a challenging disease to manage and adequate understanding of the most up to date literature can help provide comprehensive treatment strategies. RECENT FINDINGS DFSP is an infiltrative cutaneous sarcoma. It tends to have deep local invasion with a high risk of local recurrence, but a low risk of distant metastasis. It presents typically as a slow growing, asymptomatic skin lesion. It presents rarely in the head and neck, only 15% of the time. Recent data has discussed the role of wide local excision (WLE) vs. Mohs surgery. In addition, for unresectable disease the role of systemic therapy and immunomodulatory agents such as Imatinib has shown success. SUMMARY Typically, surgical management is the first line for DFSP, however the risk for local recurrence still remains high with negative margins. Due to this risk, lifelong surveillance is required after initial diagnosis and management. Similar to other head and neck tumors, most recurrences happen within the first 3 years after treatment. DFSP can be treated with WLE or Mohs. For aggressive disease that is considered unresectable systemic therapy does exist, including molecular targeted therapies.
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Affiliation(s)
- Arvind K Badhey
- Department of Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Lembo F, Cecchino LR, Parisi D, Portincasa A. Role of a new acellular dermal matrix in a multistep combined treatment of dermatofibrosarcoma protuberans of the lumbar region: a case report. J Med Case Rep 2021; 15:180. [PMID: 33875013 PMCID: PMC8056541 DOI: 10.1186/s13256-021-02787-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 03/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a rare skin fibroblastic tumor, with a high rate of recurrence. The treatment of DFSP is generally surgical, and wide local excision is the mainstay of surgical treatment. Therefore, complete assessment of all surgical margins is fundamental before definitive reconstruction. The reconstruction is a challenge for plastic surgeons, especially in particular anatomical areas (for aesthetic or functional problems) or in patients who are not candidates for more complex surgical treatments. We describe an alternative approach for reconstructive treatment of the lumbar area after wide excision of DFSP (without fresh-frozen sections) in a young obese woman with a history of smoking, using a new type of acellular dermal matrix (ADM) in a combined management protocol. The benefits of ADM are numerous: immediate wound closure and prevention of infections and excessive drying; minimal donor site morbidity; and good functional and aesthetic outcomes. Moreover, it is a temporary cover while the anatomical specimen is histologically analyzed, without donor site morbidity or prevention of any future surgery (if the margins are not tumor-free) or radiotherapy. CASE PRESENTATION In October 2019, a 34-year old obese Caucasian Woman with a history of smoking came to our institute for a multinodular growing polypoid mass in her lumbar region. An incisional biopsy diagnosed DFSP. The patient underwent proper staging. A wide local excision with 3 cm clinically healthy tissue margins down to the muscle fascia was performed and the defect was repaired using a combined approach with a new artificial bilaminar dermal template (Pelnac®, Gunze Ltd., Osaka, Japan) and a negative-pressure wound therapy system (V.A.C.®, KCI, San Antonio, USA). After the final histological examination revealed tumor-free margins, a split-thickness graft was harvested from the right gluteus and fixed to the new derma with negative-pressure wound therapy. Postoperative radiotherapy was not necessary. After 15 days, the wound had healed without complications, with satisfactory aesthetic outcome and with no limitation of back motion or pain. After 6 months of follow-up, the patient was free from disease. CONCLUSIONS This is the first reported case of Pelnac® use in DFSP reconstruction of the lumbar region. We believe that the multistep approach described herein may be a good alternative approach in selected patients with wide resections in particular anatomical areas, especially when frozen sections (with Mohs micrographic surgery) are not available.
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Affiliation(s)
- Fedele Lembo
- Unit of Reconstructive and Plastic Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti di Foggia, 71122, Foggia, Italy.
| | - Liberato Roberto Cecchino
- Unit of Reconstructive and Plastic Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti di Foggia, 71122, Foggia, Italy
| | - Domenico Parisi
- Unit of Reconstructive and Plastic Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti di Foggia, 71122, Foggia, Italy
| | - Aurelio Portincasa
- Unit of Reconstructive and Plastic Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti di Foggia, 71122, Foggia, Italy
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Baumann BC, MacArthur KM, Brewer JD, Mendenhall WM, Barker CA, Etzkorn JR, Jellinek NJ, Scott JF, Gay HA, Baumann JC, Manian FA, Devlin PM, Michalski JM, Lee NY, Thorstad WL, Wilson LD, Perez CA, Miller CJ. Management of primary skin cancer during a pandemic: Multidisciplinary recommendations. Cancer 2020; 126:3900-3906. [PMID: 32478867 PMCID: PMC7301000 DOI: 10.1002/cncr.32969] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 04/21/2020] [Accepted: 04/28/2020] [Indexed: 12/13/2022]
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, providers and patients must engage in shared decision making regarding the pros and cons of early versus delayed interventions for localized skin cancer. Patients at highest risk of COVID-19 complications are older; are immunosuppressed; and have diabetes, cancer, or cardiopulmonary disease, with multiple comorbidities associated with worse outcomes. Physicians must weigh the patient's risk of COVID-19 complications in the event of exposure against the risk of worse oncologic outcomes from delaying cancer therapy. Herein, the authors have summarized current data regarding the risk of COVID-19 complications and mortality based on age and comorbidities and have reviewed the literature assessing how treatment delays affect oncologic outcomes. They also have provided multidisciplinary recommendations regarding the timing of local therapy for early-stage skin cancers during this pandemic with input from experts at 11 different institutions. For patients with Merkel cell carcinoma, the authors recommend prioritizing treatment, but a short delay can be considered for patients with favorable T1 disease who are at higher risk of COVID-19 complications. For patients with melanoma, the authors recommend delaying the treatment of patients with T0 to T1 disease for 3 months if there is no macroscopic residual disease at the time of biopsy. Treatment of tumors ≥T2 can be delayed for 3 months if the biopsy margins are negative. For patients with cutaneous squamous cell carcinoma, those with Brigham and Women's Hospital T1 to T2a disease can have their treatment delayed for 2 to 3 months unless there is rapid growth, symptomatic lesions, or the patient is immunocompromised. The treatment of tumors ≥T2b should be prioritized, but a 1-month to 2-month delay is unlikely to worsen disease-specific mortality. For patients with squamous cell carcinoma in situ and basal cell carcinoma, treatment can be deferred for 3 months unless the individual is highly symptomatic.
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Affiliation(s)
- Brian C. Baumann
- Department of Radiation OncologyWashington University in St. LouisSt. LouisMissouriUSA
- Department of Radiation OncologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kelly M. MacArthur
- Division of Dermatologic SurgeryWashington University in St. LouisSt. LouisMissouriUSA
| | - Jerry D. Brewer
- Division of Dermatologic SurgeryMayo ClinicRochesterMinnesotaUSA
| | - William M. Mendenhall
- Department of Radiation OncologyUniversity of Florida at GainesvilleGainesvilleFloridaUSA
| | - Christopher A. Barker
- Department of Radiation OncologyMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Jeremy R. Etzkorn
- Division of Dermatologic Surgery, Department of DermatologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Nathaniel J. Jellinek
- Dermatology Professionals IncEast GreenwichRhode IslandUSA
- Division of Dermatologic Surgery, Department of DermatologyBrown UniversityProvidenceRhode IslandUSA
- Division of Dermatologic Surgery, Department of DermatologyUniversity of MassachusettsWorcesterMassachusettsUSA
| | - Jeffrey F. Scott
- Division of Dermatologic Surgery, Department of DermatologyJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Hiram A. Gay
- Department of Radiation OncologyWashington University in St. LouisSt. LouisMissouriUSA
| | | | - Farrin A. Manian
- Department of Internal MedicineMassachusetts General Hospital, Harvard UniversityBostonMassachusettsUSA
| | - Phillip M. Devlin
- Department of Radiation OncologyBrigham and Women's Hospital, Harvard UniversityBostonMassachusettsUSA
| | - Jeff M. Michalski
- Department of Radiation OncologyWashington University in St. LouisSt. LouisMissouriUSA
| | - Nancy Y. Lee
- Department of Radiation OncologyMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Wade L. Thorstad
- Department of Radiation OncologyWashington University in St. LouisSt. LouisMissouriUSA
| | - Lynn D. Wilson
- Department of Therapeutic RadiologyYale UniversityNew HavenConnecticutUSA
| | - Carlos A. Perez
- Department of Radiation OncologyWashington University in St. LouisSt. LouisMissouriUSA
| | - Christopher J. Miller
- Division of Dermatologic Surgery, Department of DermatologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Chappell AG, Doe SC, Worley B, Yoo SS, Gerami P, Alam M, Buck DW, Kim JYS, Wayne JD. Multidisciplinary surgical treatment approach for dermatofibrosarcoma protuberans: an update. Arch Dermatol Res 2020; 313:367-372. [PMID: 32770258 DOI: 10.1007/s00403-020-02124-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/13/2020] [Accepted: 07/31/2020] [Indexed: 10/23/2022]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a cutaneous sarcoma that has remained a challenge for oncologic and reconstructive surgeons due to a high rate of local recurrence. The objective of this study is to investigate the oncologic and reconstructive benefits of employing a multidisciplinary two-step approach to the treatment of DFSP. A retrospective review was conducted using a prospectively collected database of all patients who underwent resection and reconstruction of large DFSPs by a multidisciplinary team, including a Mohs micrographic surgeon, surgical oncologist, dermatopathologist, and plastic and reconstructive surgeon, at one academic institution from 1998-2018. Each patient underwent Mohs micrographic surgery for peripheral margin clearance (Step 1) followed by wide local excision (WLE) of the deep margin by surgical oncology and immediate reconstruction by plastic surgery (Step 2). 57 patients met inclusion criteria. Average defect size after WLE (Step 2): 87.3 cm2 (range 8.5-1073.5 cm2). Mean follow-up time was 37 months (range 0-138 months). There were no cases of recurrence. A two-step multidisciplinary surgical treatment approach for DFSP minimizes risk of recurrence, decreases patient discomfort, and allows immediate reconstruction after deep margin clearance.
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Affiliation(s)
- Ava G Chappell
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Sydney C Doe
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Brandon Worley
- Department of Dermatology, Northwestern Feinberg School of Medicine, Arkes Pavilion, Suite 650, 676 N St Clair Street, Chicago, IL, 60611, USA
| | - Simon S Yoo
- Department of Dermatology, Northwestern Feinberg School of Medicine, Arkes Pavilion, Suite 650, 676 N St Clair Street, Chicago, IL, 60611, USA
| | - Pedram Gerami
- Department of Dermatology, Northwestern Feinberg School of Medicine, Arkes Pavilion, Suite 650, 676 N St Clair Street, Chicago, IL, 60611, USA
| | - Murad Alam
- Department of Dermatology, Northwestern Feinberg School of Medicine, Arkes Pavilion, Suite 650, 676 N St Clair Street, Chicago, IL, 60611, USA
| | - Donald W Buck
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University- St. Louis School of Medicine, St. Louis, MO, USA
| | - John Y S Kim
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Jeffrey D Wayne
- Department of Dermatology, Northwestern Feinberg School of Medicine, Arkes Pavilion, Suite 650, 676 N St Clair Street, Chicago, IL, 60611, USA. .,Division of Surgical Oncology, Department of Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, USA.
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Huis In 't Veld EA, Grünhagen DJ, van Coevorden F, Smith MJ, van Akkooi AC, Wouters MWJM, Verhoef C, Strauss DC, Hayes AJ, van Houdt WJ. Adequate surgical margins for dermatofibrosarcoma protuberans - A multi-centre analysis. Eur J Surg Oncol 2020; 47:436-442. [PMID: 32773140 DOI: 10.1016/j.ejso.2020.06.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/04/2020] [Accepted: 06/11/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive tumour. Adequate margins have a positive impact on recurrence rates. The aim of this study is to assess how adequate margins are achieved and secondly which additional treatment modalities might be necessary to achieve adequate margins. MATERIAL & METHODS Patients with DFSP treated between 1991 and 2016 at three tertiary centres were included. Patient- and tumour characteristics were obtained from a prospectively held database and patient files. RESULTS A total of 279 patients with a median age of 39 (Interquartile range [IQ], 31-50) years and a median follow-up of 50 (IQ, 18-96) months were included. When DFSP was preoperatively confirmed by biopsy and resected with an oncological operation in a tertiary centre, in 86% was had clear pathological margins after one excision. Wider resection margins were significantly correlated with more reconstructions (p = 0.002). A substantial discrepancy between the primary surgical macroscopic and the pathological margins was found with a median difference of 22 (range, 10-46) mm (Fig. 1). There was no significant influence of the width of the pathological clear margins (if > 1 mm) and the recurrence rate (p = 0.710). CONCLUSION The wider the resection margins, the more likely it is to obtain clear pathological margins, but the more likely patients will need any form of reconstruction after resection. The aim of the primary excision should be wide surgical resection, where the width of the margin should be balanced against the need for reconstructions and surgical morbidity.
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Affiliation(s)
- E A Huis In 't Veld
- Department of Surgical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
| | - D J Grünhagen
- Department of Surgical Oncology, Erasmus MC, Cancer Institute, Rotterdam, the Netherlands
| | - F van Coevorden
- Department of Surgical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - M J Smith
- Sarcoma Unit, Department of Surgery, Royal Marsden Hospital, London, United Kingdom
| | - A C van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - M W J M Wouters
- Department of Surgical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - C Verhoef
- Department of Surgical Oncology, Erasmus MC, Cancer Institute, Rotterdam, the Netherlands
| | - D C Strauss
- Sarcoma Unit, Department of Surgery, Royal Marsden Hospital, London, United Kingdom
| | - A J Hayes
- Sarcoma Unit, Department of Surgery, Royal Marsden Hospital, London, United Kingdom
| | - W J van Houdt
- Department of Surgical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, the Netherlands
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Essid L, Sassi S, Khelil K, Sbai MA, Maalla R. The surgical management of a hypogastric dermatofibrosarcoma protuberans. Pan Afr Med J 2019; 34:116. [PMID: 31934257 PMCID: PMC6945386 DOI: 10.11604/pamj.2019.34.116.17740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 09/24/2019] [Indexed: 11/28/2022] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is an uncommon skin tumor with intermediate grade of malignancy. Wide surgical resection with disease-free margin offers an excellent probability of cure. These large excisions cause large skin defect that can be difficult to cover. Through this case report we describe a surgically treated DFSP that was covered by a Mc Gregor flap; which despite its seniority is still relevant and continues to serve plastic surgery.
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Affiliation(s)
- Leila Essid
- Orthopaedic and Trauma Department, Maamouri Hospital, Nabeul, Tunisia
| | - Selim Sassi
- General Surgery Department, Maamouri Hospital, Nabeul, Tunisia
| | - Khaled Khelil
- Orthopaedic and Trauma Department, Maamouri Hospital, Nabeul, Tunisia
| | - Mohamed Ali Sbai
- Orthopaedic and Trauma Department, Maamouri Hospital, Nabeul, Tunisia
| | - Riadh Maalla
- Orthopaedic and Trauma Department, Rabta Hospital, Tunis, Tunisia
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8
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Role of postoperative radiotherapy in dermatofibrosarcoma protuberans: a propensity score-matched analysis. Radiat Oncol 2019; 14:20. [PMID: 30696463 PMCID: PMC6350344 DOI: 10.1186/s13014-019-1226-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/20/2019] [Indexed: 12/03/2022] Open
Abstract
Objective This study aimed to evaluate the role of postoperative radiotherapy (RT) in dermatofibrosarcoma protuberans (DFSP) and identify the prognostic factors influencing the disease-free survival (DFS). Methods A total of 184 patients with DFSP were analyzed from 2000 to 2016. The regression model was used to examine the prognostic factors for DFS. Baseline covariates were balanced using a propensity score model. The role of RT was assessed by comparing the DFS of the surgery + RT group with that of the surgery group. Results The median follow-up was 58 months (range, 6–203 months). The 5-year DFS rate was 89.8%. The univariate analysis showed that age ≥ 50 years, presence of fibrosarcoma, margins < 2 cm, and tumor size ≥5 cm were associated with worse DFS (P = 0.002, P < 0.001, P = 0.030, and P = 0.032, respectively). The multivariate Cox regression model revealed that age, margin width, lesion number, and histological subtype independently affected DFS. The Ki-67 expression was related to age and histological subtype. Patients with Ki-67 ≥ 17% showed a worse DFS than those with Ki-67 < 17% (35.8% vs 87.8%, P = 0.002). In the matched cohort, DFS was significantly higher in the S + RT group than in the S group (5-year DFS, 88.1% vs 56.2%, P = 0.044). Conclusions Age, margin width, lesion number, and histological subtype were independent risk factors for DFS in patients with DFSP. The high expression of Ki-67 could predict a poor prognosis. Postoperative RT could improve DFS for patients with DFSP.
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Huis in ‘t Veld EA, van Coevorden F, Grünhagen DJ, Smith MJ, van Akkooi ACJ, Wouters MWJM, Hayes AJ, Verhoef C, Strauss DC, van Houdt WJ. Outcome after surgical treatment of dermatofibrosarcoma protuberans: Is clinical follow‐up always indicated? Cancer 2019; 125:735-741. [DOI: 10.1002/cncr.31924] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Eva A. Huis in ‘t Veld
- Sarcoma Unit, Department of Surgery Royal Marsden Hospital London United Kingdom
- Sarcoma Unit, Department of Surgical Oncology Netherlands Cancer Institute‐Antoni van Leeuwenhoek Amsterdam The Netherlands
| | - Frits van Coevorden
- Sarcoma Unit, Department of Surgical Oncology Netherlands Cancer Institute‐Antoni van Leeuwenhoek Amsterdam The Netherlands
| | - Dirk J. Grünhagen
- Department of Surgical Oncology Erasmus Medical Center‐Daniel den Hoed Cancer Center Rotterdam The Netherlands
| | - Myles J. Smith
- Sarcoma Unit, Department of Surgery Royal Marsden Hospital London United Kingdom
| | - Alexander C. J. van Akkooi
- Sarcoma Unit, Department of Surgical Oncology Netherlands Cancer Institute‐Antoni van Leeuwenhoek Amsterdam The Netherlands
| | - Michel W. J. M. Wouters
- Sarcoma Unit, Department of Surgical Oncology Netherlands Cancer Institute‐Antoni van Leeuwenhoek Amsterdam The Netherlands
| | - Andrew J. Hayes
- Sarcoma Unit, Department of Surgery Royal Marsden Hospital London United Kingdom
| | - Cornelis Verhoef
- Department of Surgical Oncology Erasmus Medical Center‐Daniel den Hoed Cancer Center Rotterdam The Netherlands
| | - Dirk C. Strauss
- Sarcoma Unit, Department of Surgery Royal Marsden Hospital London United Kingdom
| | - Winan J. van Houdt
- Sarcoma Unit, Department of Surgery Royal Marsden Hospital London United Kingdom
- Sarcoma Unit, Department of Surgical Oncology Netherlands Cancer Institute‐Antoni van Leeuwenhoek Amsterdam The Netherlands
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Abstract
Dermatofibrosarcoma protuberans (DFSP) is a rare superficial soft tissue sarcoma. Its rarity precludes large prospective studies. Clinical diagnosis requires an high index of suspicion. Effective management requires an appreciation of tumor biology and the nature of the characteristic infiltrative growth pattern. DFSP tends to recur locally, with a low risk of dissemination. Aggressive surgical resection with widely negative margins is essential to management. Radiotherapy may be indicated in special circumstances. Understanding the molecular pathogenesis has resulted in use of tyrosine kinase inhibitor therapy for patients with locally advanced disease or in metastatic disease. DFSP patients require long-term follow-up.
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Ma C, Sun Y, Yang X, Zhang Q, Zhang C, Cui L. Improving precision of resection by pre-surgery inspections with contrast-enhanced ultrasound for dermatofibrosarcoma protuberans. Dermatol Ther 2016; 29:473-475. [PMID: 27572421 DOI: 10.1111/dth.12401] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 07/18/2016] [Accepted: 07/26/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Chuan Ma
- Department of Dermatology; Peking University Third Hospital; Beijing China
| | - Yang Sun
- Department of Ultrasonography; Peking University Third Hospital; Beijing China
| | - Xin Yang
- Department of Plastic Surgery; Peking University Third Hospital; Beijing China
| | - Qian Zhang
- Department of Dermatology; Peking University Third Hospital; Beijing China
| | - Chunlei Zhang
- Department of Dermatology; Peking University Third Hospital; Beijing China
| | - Ligang Cui
- Department of Ultrasonography; Peking University Third Hospital; Beijing China
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Budak MJ, Weir-McCall JR, Yeap PM, White RD, Waugh SA, Sudarshan TAP, Zealley IA. High-Resolution Microscopy-Coil MR Imaging of Skin Tumors: Techniques and Novel Clinical Applications. Radiographics 2016; 35:1077-90. [PMID: 26172352 DOI: 10.1148/rg.2015140142] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
High-resolution magnetic resonance (MR) imaging performed with a microscopy coil is a robust radiologic tool for the evaluation of skin lesions. Microscopy-coil MR imaging uses a small surface coil and a 1.5-T or higher MR imaging system. Simple T1- and T2-weighted imaging protocols can be implemented to yield high-quality, high-spatial-resolution images that provide an excellent depiction of dermal anatomy. The primary application of microscopy-coil MR imaging is to delineate the deep margins of skin tumors, thereby providing a preoperative road map for dermatologic surgeons. This information is particularly useful for surgeons who perform Mohs micrographic surgery and in cases of nasofacial neoplasms, where the underlying anatomy is complex. Basal cell carcinoma is the most common nonmelanocytic skin tumor and has a predilection to manifest on the face, where it can be challenging to achieve complete surgical excision while preserving the cosmetic dignity of the patient. Microscopy-coil MR imaging provides dermatologic surgeons with valuable preoperative anatomic information that is not available at conventional clinical examination.
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Affiliation(s)
- Matthew J Budak
- From the Departments of Clinical Radiology (M.J.B., J.R.W.M., P.M.Y., T.A.P.S., I.A.Z.) and Medical Physics (S.A.W.), Ninewells Hospital, Dundee, Scotland; and Department of Clinical Radiology, University Hospital of Wales, Cardiff, Wales (R.D.W.)
| | - Jonathan R Weir-McCall
- From the Departments of Clinical Radiology (M.J.B., J.R.W.M., P.M.Y., T.A.P.S., I.A.Z.) and Medical Physics (S.A.W.), Ninewells Hospital, Dundee, Scotland; and Department of Clinical Radiology, University Hospital of Wales, Cardiff, Wales (R.D.W.)
| | - Phey M Yeap
- From the Departments of Clinical Radiology (M.J.B., J.R.W.M., P.M.Y., T.A.P.S., I.A.Z.) and Medical Physics (S.A.W.), Ninewells Hospital, Dundee, Scotland; and Department of Clinical Radiology, University Hospital of Wales, Cardiff, Wales (R.D.W.)
| | - Richard D White
- From the Departments of Clinical Radiology (M.J.B., J.R.W.M., P.M.Y., T.A.P.S., I.A.Z.) and Medical Physics (S.A.W.), Ninewells Hospital, Dundee, Scotland; and Department of Clinical Radiology, University Hospital of Wales, Cardiff, Wales (R.D.W.)
| | - Shelley A Waugh
- From the Departments of Clinical Radiology (M.J.B., J.R.W.M., P.M.Y., T.A.P.S., I.A.Z.) and Medical Physics (S.A.W.), Ninewells Hospital, Dundee, Scotland; and Department of Clinical Radiology, University Hospital of Wales, Cardiff, Wales (R.D.W.)
| | - Thiru A P Sudarshan
- From the Departments of Clinical Radiology (M.J.B., J.R.W.M., P.M.Y., T.A.P.S., I.A.Z.) and Medical Physics (S.A.W.), Ninewells Hospital, Dundee, Scotland; and Department of Clinical Radiology, University Hospital of Wales, Cardiff, Wales (R.D.W.)
| | - Ian A Zealley
- From the Departments of Clinical Radiology (M.J.B., J.R.W.M., P.M.Y., T.A.P.S., I.A.Z.) and Medical Physics (S.A.W.), Ninewells Hospital, Dundee, Scotland; and Department of Clinical Radiology, University Hospital of Wales, Cardiff, Wales (R.D.W.)
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14
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Dermatofibrosarcoma Protuberans: an Update and Review. CURRENT DERMATOLOGY REPORTS 2015. [DOI: 10.1007/s13671-015-0120-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Chan TC, Wu CJ, Jeng SF. Dermatofibrosarcoma protuberans: A 10-year experience. FORMOSAN JOURNAL OF SURGERY 2015. [DOI: 10.1016/j.fjs.2014.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Loghdey MS, Varma S, Rajpara SM, Al-Rawi H, Perks G, Perkins W. Mohs micrographic surgery for dermatofibrosarcoma protuberans (DFSP): a single-centre series of 76 patients treated by frozen-section Mohs micrographic surgery with a review of the literature. J Plast Reconstr Aesthet Surg 2014; 67:1315-21. [PMID: 25012249 DOI: 10.1016/j.bjps.2014.05.021] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Revised: 04/13/2014] [Accepted: 05/03/2014] [Indexed: 11/19/2022]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a rare low-grade sarcoma that typically presents with local invasion but rarely metastasises. Surgical excision remains the first-line treatment for DFSP. There are no randomised controlled or prospective studies comparing wide local excision (WLE) with Mohs micrographic surgery (MMS), but available evidence from the retrospective studies and case series available has consistently shown higher recurrence rates for standard surgery and WLE than for MMS. Combined recurrence rates of data within the last 20 years for WLE have been reported at 7.3% compared with 1.1% for MMS. Our aim was to review the clinical details and recurrence rates of DFSP cases treated with frozen-section MMS in our centre between 1996 and February 2013. The relevant data were collected from the case notes. It involved 76 patients with nine of these patients lost to follow-up. In the remaining 67 (67/76) cases, the recurrence rate was 1.5% during the mean follow-up period of 50 months (2-132). This is comparable to recurrence rates for the MMS in the literature [20,21]. Our series is the largest series for frozen-section MMS reported to date. Based on these findings and the current literature evidence, we advocate MMS as the treatment of choice for DFSP in all locations.
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Affiliation(s)
| | - Sandeep Varma
- Department of Dermatology, Queens Medical Centre, Derby Road, Nottingham NG7 2UH, UK
| | - Sanjay M Rajpara
- Department of Dermatology, Queens Medical Centre, Derby Road, Nottingham NG7 2UH, UK
| | - Haytham Al-Rawi
- Department of Dermatology, Queens Medical Centre, Derby Road, Nottingham NG7 2UH, UK
| | - Graeme Perks
- Department of Plastic Surgery, Queens Medical Centre, Derby Road, Nottingham NG7 2UH, UK
| | - William Perkins
- Department of Dermatology, Queens Medical Centre, Derby Road, Nottingham NG7 2UH, UK
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Bertolli E, Campagnari M, Molina AS, Macedo MP, Pinto CAL, Cunha IW, Duprat Neto JP. Artificial dermis (Matriderm®) followed by skin graft as an option in dermatofibrosarcoma protuberans with complete circumferential and peripheral deep margin assessment. Int Wound J 2013; 12:545-7. [PMID: 24102765 DOI: 10.1111/iwj.12157] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 08/01/2013] [Accepted: 08/02/2013] [Indexed: 12/01/2022] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a locally invasive neoplasia with a pattern of infiltrative growth that leads to extended resections. To avoid unnecessary resections and spare tissues, its treatment requires an adequate assessment of the margins. We present a case where artificial dermis (Matriderm®) was used followed by skin graft for reconstruction. We present a 50-year-old woman with a DFSP in the occipital region. She was referred to us after a first surgery with positive margins. A wide local excision with a 2-cm margin was performed and periosteal tissue was also removed, which led to exposure of the skull. Matriderm was placed on the bone surface and dressings were changed every other day. Meanwhile, margins were evaluated by the complete circumferential and peripheral deep margin assessment (CCPDMA) and were positive for DFSP in the superior margin. After 4 weeks the area was completely covered by granulation tissue and a new resection followed by reconstruction with a skin graft was performed. With regard to the difficulties in the margin assessment in DFSP, we present artificial dermis (Matriderm) as an option for reconstructive surgery in these patients, especially when a skin graft cannot be performed as a first option.
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Affiliation(s)
| | | | - André S Molina
- Skin Cancer Department, Hospital AC Camargo, São Paulo, Brazil
| | | | | | - Isabela W Cunha
- Pathology Department, Hospital AC Camargo, São Paulo, Brazil
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18
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Vance KK, Pytynia KB, Antony AK, Krunic AL. Mohs moat: Peripheral cutaneous margin clearance in a collaborative approach for aggressive and deeply invasive basal cell carcinoma. Australas J Dermatol 2013; 55:198-200. [DOI: 10.1111/ajd.12071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 04/01/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Karl K Vance
- Department of Dermatology; University of Illinois; Chicago Illinois USA
| | - Kristen B Pytynia
- Department of Otolaryngology, Head and Neck Surgery; University of Illinois; Chicago Illinois USA
| | - Anuja K Antony
- Division of Plastic, Reconstructive and Cosmetic Surgery; Department of Surgery; University of Illinois; Chicago Illinois USA
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19
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Dalle S. [What's new in oncology?]. Ann Dermatol Venereol 2013; 139 Suppl 5:S217-22. [PMID: 23522708 DOI: 10.1016/s0151-9638(12)70136-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In cutaneous oncology, the year 2012 was marked by the consolidation of earlier results as well as the emergence of new therapeutic perspectives. The consolidated results most notably concern the use of MAP-kinase inhibitors (anti-MEK, anti-BRAF) in the treatment of patients with metastatic melanoma. Vismodegib (an SMO inhibitor), used in the treatment of multiple basocellular carcinomas that are inoperable or that have developed in patients suffering from Gorlin syndrome, has been the subject of publication of large-scale studies. Of the new therapeutic advances, let us mention the use of inhibitors or monoclonal antibodies directed against the PD1 receptor and its ligand PD-L1, the combination of MEK and BRAF inhibitors in the treatment of metastatic melanoma, and treatment in adjuvant situations with these same inhibitors. Beyond these significant advances that must be credited to cutaneous oncology, new questions are emerging relative to the side effects observed with these targeted therapies. The onset of multiple epidermoid carcinomas or primary melanomas treated with BRAF inhibitors is a striking illustration of the paradoxes arising from the clinical transfer of scientific progress. The intellectual perspectives are therefore numerous. It is hoped that this work will succeed in making these innovative drugs available to the patients who will have contributed to their development through their participation in clinical trials.
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Affiliation(s)
- S Dalle
- Service de Dermatologie, Centre Hospitalier Lyon Sud, 165, chemin du Grand Revoyet, 69495 Pierre Bénite cedex 08, France.
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