Dermatofibrosarcoma protuberans (DFSP) with fibrosarcomatous changes in a patient with psoriasis treated with adalimumab

Dermatofibrosarcoma Protuberans (DFSP) with Fibrosarcomatous Changes in a Patient with Crohn's Disease Treated with Anti-TNF (Adalimumab)

Dermatofibrosarcoma protuberans (DFSP) is a low-to-intermediate grade sarcoma with a reported incidence of 4.1 per million person-years. Despite its local invasiveness, it rarely metastasizes (5% of cases). Fibrosarcomatous change in DFSP is a form of tumor progression that carries an increased risk of metastases. We reported a case of 45-year-old patient treated with adalimumab lasting 7 years for Crohn's disease who developed dermatofibrosarcoma protuberans with fibromatous changes. Adalimumab therapy was stopped before surgery, and ustekinumab was introduced 6 months after.

Giant keystone type III perforator flaps for dermatofibrosarcoma protuberans defect reconstruction

INTRODUCTION

Dermatofibrosarcoma protuberans (DFSP) is a relatively rare malignant tumor, with important local aggressiveness.

CASE REPORT

We present a case of a 59-years-old man with a history of Psoriasis and viral hepatitis C presented in our department with a giant lesion on the posterior trunk, of 24/36 cm, with pus and local bleeding, causing important anemia. The tumor was excised, creating an elliptical defect of around 34 × 42 cm down to fascial level, which was covered by two lateral flaps - modified Keystone type III.

RESULTS

The flaps were completely viable and integrated with small dehiscence, which were assisted to heal secondarily.

CONCLUSION

Our paper presents a reliable alternative to skin grafting for a very large defect on the posterior trunk, the modified type III keystone flap, to our knowledge, for the first time presented for such a wide defect and on adult.