High immunohistochemical nestin expression is associated with greater depth of infiltration in dermatofibrosarcoma protuberans: a study of 71 cases

Recurrence of a dermatofibrosarcoma protuberans? Rare case

Dermatofibrosarcoma protuberans (DFS) is a mesenchymal-origin skin tumor with intermediate malignancy. Though rare, it's not exceptional, comprising about 0.1% of malignant skin tumors. The authors discuss clinical, radiological, histopathological studies, and various therapeutic modalities for this tumor. Our 82-year-old patient presented with a 3 cm swelling on the right arm, initially undergoing biopsy followed by surgical excision of the mass. Adjuvant treatment with radiotherapy or chemotherapy is unnecessary unless recurrence or malignant transformation occurs. Histological analysis is crucial for diagnosis. The preferred treatment method is wide surgical excision. Prognosis primarily depends on malignancy, especially at the local level, with a high risk of recurrence. It's rare for a distinctly malignant sarcomatous transformation with metastasis to occur.

Effective resection of dermatofibrosarcoma protuberans using the novel Saturn's rings technique

Dermatofibrosarcoma protuberans (DFSP) is a rare, low-grade sarcoma with locally infiltrative characteristics. A wide excision is made with a 5 cm gross margin. However, recently, Mohs micrographic surgery has emerged as an alternative. In this study, we evaluate a novel method (Saturn's Rings technique) for removing tumors that combines the advantages of wide excision and Mohs micrographic surgery. Between September 2001 and March 2020, 29 patients with DFSP, excluding the head and neck, were treated using Saturn's rings technique. Frozen biopsies were performed at regular intervals under various conditions and depths. If the biopsy was positive, a negative margin was obtained through an additional session. The depth and breadth of excision, reconstruction method, and postoperative recurrence were analyzed. The breadth of excision was evaluated at 1 cm intervals. Only 1 session was required in 12 cases, 2 sessions were needed in 13 cases, and 3 or more sessions were performed in 4 cases. In 24 cases, the depth of excision was limited to above the superficial fascia, with a negative biopsy of the superficial fascia. Local flaps were the most common reconstruction method (n = 21, 72.4%). No cases of recurrence were observed at follow-up (average, 45.7 months). Saturn's rings technique for DFSP maximized the preservation of normal tissue with minimal resection, was advantageous for reconstruction, and yielded good results without recurrence.