Risk factors related to postoperative recurrence of dermatofibrosarcoma protuberans: A retrospective study and literature review

In vitro modeling of recurrent Dermatofibrosarcoma Protuberans: Assessment of 5-aminolevulinic acid photodynamic therapy efficacy

BACKGROUND

Dermatofibrosarcoma Protuberans (DFSP) is a rare, low-grade malignant tumor of the dermis with a high recurrence rate post-surgery. Current treatments, including surgery, radiotherapy, and targeted therapy, have limitations. Photodynamic therapy (PDT) with 5-aminolevulinic acid (5-ALA) is a promising non-invasive approach, but its efficacy in DFSP treatment remains underexplored.

METHODS

This study aimed to evaluate the anti-tumor efficacy of 5-ALA PDT using an in vitro model derived from a recurrent DFSP patient. The cells were treated with varying concentrations of 5-ALA and exposed to red light, followed by assessments of cell viability, proliferation, apoptosis, migration, invasion, angiogenesis, and expression of DFSP-related genes and proteins.

RESULTS

5-ALA PDT significantly reduced DFSP cell viability in a dose-dependent manner and induced apoptosis. It also effectively inhibited cell proliferation, migration, and invasion, as well as suppressed angiogenic activity in conditioned media. Furthermore, 5-ALA PDT downregulated the expression of COL1A1 and PDGFRB, key genes in DFSP pathogenesis.

CONCLUSIONS

The findings provide the first evidence of 5-ALA PDT's in vitro anti-tumor efficacy against DFSP, suggesting its potential as a novel therapeutic approach for DFSP. Further studies are warranted to explore the clinical utility of 5-ALA PDT in preventing DFSP recurrence.

Dermatofibrosarcoma protuberans in a pre-adolescent child

INTRODUCTION

Dermatofibrosarcoma protuberans (DFSP) is a rare skin sarcoma with a slow growth rate and less chance of metastasizing but it is associated with higher morbidity due to its aggressive nature of local infiltration and its recurrence nature.

IMPORTANCE

When dealing with DFSP in children we could achieve low morbidity with appropriate surgical planning and approach even though aggressive wide local excision was performed.

CASE REPORT

12-year boy presented with a lump in his left arm which was initially clinically and ultrasonically diagnosed as lipoma. However, histological examination, coupled with CD34 immunohistochemistry, confirmed the diagnosis as DFSP.

CLINICAL DISCUSSION

Modern microsurgical methods, such as Mohs micrographic surgery, are advocated as effective treatment options, their availability and feasibility may be limited in certain settings. Therefore, the classic approach of wide local excision remains the treatment of choice in the majority of cases, with radiotherapy recommended for recurrent disease. Proper patient education and regular surveillance will help identify recurrence in time which aids us to provide timely intervention and optimize outcomes for patients with dermatofibrosarcoma protuberans.

CONCLUSION

Accurate diagnosis using histology coupled with immunohistochemistry, proper surgical technique and regular follow up are the three pillars of managing DFSP.

Dermatofibrosarcoma protuberans challenges: a case series and review of the literature

BACKGROUND

Dermatofibrosarcoma protuberans (DFSP) is a rare variant of skin sarcoma which is characterized by proliferation of spindle cells in a storiform pattern. Although it is mostly benign in its primary stages, it can cause a high burden of morbidity unless it is thoroughly excised.

CASE PRESENTATION

Here, we review six cases of DFSP which were characterized by skin lesions in various parts of the body. Patients were from 26 to 51 years old; four were Asian men and two were Asian women. Wide surgical excision was performed for all these patients and no extra treatment was considered. Samples were studied by hematoxylin and eosin (H&E) staining and immunohistochemical (IHC) tests. Only one of our patients experienced recurrence after the initial surgery.

CONCLUSION

Determining the best surgical method is still a dilemma in the treatment of DFSP lesions. There are numerous studies to prove the efficacy of various surgical interventions. Although DFSP is not commonly known as a malignant skin lesion, delay in treatment will have a catastrophic impact on patients' lives. Thus, applying an in-time surgical method (wide local excision in our cases) in treating DFSP is crucial in preventing recurrence as well as decreasing the morbidity burden of DFSP.