Dermatofibrosarcoma protuberans of the vulva: margins assessment and reconstructive options - a report of two cases

Reconstructive Surgery in the Elderly: A Case Report on Maintaining the Quality of Life in a Patient with Vulvar Dermatofibrosarcoma Protuberans

BACKGROUND

Dermatofibrosarcoma protuberans (DFSP) is a rare proliferative condition representing skin sarcomas known to locally recur yet very rarely known to metastasize. A typical characteristic is trunk localization, making vulvar occurrences an exception. Complete resection is the primary treatment.

CASE REPORT

We present an unusual case of twice-recurrent vulvar DFSP in a 92-year-old woman. Wide local excision with tumor-negative margins (R0 resection) of a grapefruit-sized mass was followed by a rhomboid skin flap transplantation to address a substantial skin deficit at the post excision site. At 14-month follow-up, no signs of recurrence were present, all wounds were healed, and the esthetic results were assessed as highly adequate.

CONCLUSIONS

This study is an argument for the role of reconstructive surgery in patients of advanced age undergoing oncological procedures; skin transplantations should be considered regardless of the patient's age. We also provide an updated review on vulvar DFSP.

Dermatofibrosarcoma Protuberans of the Vulva: A Review of the MITO Rare Cancer Group

BACKGROUND

Vulvar dermatofibrosarcoma protuberans is an extremely rare disease. Its rarity can hamper the quality of treatment; deeper knowledge is necessary to plan appropriate management. The purpose of this review is to analyse the data reported in the literature to obtain evidence regarding appropriate disease management.

METHODS

We made a systematic search of the literature, including the terms "dermatofibrosarcoma protuberans", "vulva", and "vulvar", alone or in combination. We selected articles published in English from two electronic databases, PubMed and MEDLINE, and we analysed their reference lists to include other potentially relevant studies.

RESULTS

We selected 39 articles, with a total of 68 cases reported; they were retrospective case reports and case series. Dermatofibrosarcoma protuberans of the vulva tends towards local recurrence; an early and timely pathological diagnosis, together with an appropriate surgical approach, are of utmost importance to ensure free margins and maximise the curative potential.

CONCLUSIONS

Even if this is an indolent disease and it generally shows a good prognosis, appropriate management may help in reducing the rate of local recurrences that may hamper patients' quality of life. Management by a multidisciplinary team is highly recommended.

Recurrent Dermatofibrosarcoma Protuberans of the Vulva: A Rare Occurrence and Review of Literature

Objective: Dermatofibrosarcoma protuberans (DFSP) of the vulva is an uncommon soft tissue tumor with fewer than 60 cases reported previously. Distant metastasis is rare with a high propensity for local invasion. Surgical management is the gold standard with adequate margin excision to prevent future recurrences. We report a case of vulvar DFSP requiring three resections to achieve primary clearance. To the best of our knowledge, this is the first case report from India.

Case report: A 35-years-old female, presented with nodular vulvar mass for the third time arising from the upper part of right labia majora for the last year. She had a history of two similar episodes in the past for which excision was done and histopathology confirmed DFSP. The third wide local resection was performed with 3 cm margins and the margins were sent for intra-operative frozen section analysis, which was confirmed clear by the pathologist. The patient has been free of recurrence for two years.

Conclusion: DFSP is a challenging condition presenting as a non-tender nodular mass characterized by local invasion and recurrence. Early diagnosis and appropriate management using wide local excision with accurate margin assessment can achieve optimal results and prevent future recurrences.

Dermal Substitutes Use in Reconstructive Surgery for Skin Tumors: A Single-Center Experience

Reconstructive surgery following skin tumor resection can be challenging. Treatment options after removing the tumor are skin grafting, local pedicled and axial flaps, or microsurgery for complex and extensive wounds correction. Recently, the use of dermal substitutes has been extended to reconstructive surgery in cutaneous oncology. Objectives. To report both a single-center experience using dermal substitutes in reconstructive surgery for skin malignancies and reconstructive surgery's outcomes. Methods and Results. Among thirteen patients, seven (53.8%) were male with mean age of 62.6 years. Regarding diagnosis, there were five cases (38.5%) of basal cell carcinoma (BCC), two (15.4%) of melanoma in situ, two (15.4%) of dermatofibrosarcoma protuberans, one (7.7%) of squamous cell carcinoma (SCC), one (7.7%) of angiosarcoma, and one (7.7%) of eccrine carcinoma (EC). The most common site of injury was scalp (53.8%) and lower limbs (23.1%). Seven (53.8%) patients used NPWT and six (46.2%) patients underwent Brown's dressing. The most frequent complication of the first stage was wound contamination (38.5%). Average time to second-stage skin grafting was 43.9 days. Three (23%) patients developed tumor recurrence and one died. Conclusions. Use of dermal substitutes in oncology can be an option for reconstruction after extended resections, providing good aesthetical and functional results.