Dermatologic surgery
Three-dimensional histology for dermatofibrosarcoma protuberans: Case series and surgical technique

https://doi.org/10.1016/j.jaad.2012.03.034Get rights and content

Background

Dermatofibrosarcoma protuberans (DFSP) is a low-grade malignant skin tumor that may also infiltrate dermis and subcutaneous tissue. Although the mainstay of treatment has been wide local excision, during the last decade three-dimensional (3D) histology surgery has proven very effective for the treatment of this tumor.

Objective

We sought to evaluate the effectiveness of 3D histology surgery for the treatment of DFSP.

Methods

We retrospectively reviewed charts of patients with DFSP treated in our unit with 3D histology surgery between April 2000 and May 2011. Age at onset, gender, duration of tumor, previous treatment, lesion site, number of surgical stages, postsurgical defect size, closure technique, and follow-up were registered.

Results

A total of 29 patients were included. Mean patient age was 40.7 years. Fifteen lesions were located on the trunk, 11 on the extremities, and 3 in the head and neck region. Twelve patients had primary tumors and 17 were referred to us after incomplete excision. The average number of 3D histology surgical stages required for tumor clearance was 1.4. Mean postsurgical defect size was 26 cm2. All lateral and deep borders excised were tumor-free. Mean follow-up period was 68 months (range 12-142 months) with a 0% recurrence rate.

Limitations

This was a retrospective review.

Conclusion

Three-dimensional histology surgery with paraffin sections is effective for the treatment of DFSP and feasible in an outpatient setting. The low recurrence rates obtained confirm the oncologic efficacy of the procedure. Furthermore, designing closure on the basis of focally affected margins improves functional and aesthetic outcomes without compromising oncological effectiveness.

Section snippets

Methods

The medical records of all patients with DFSP treated in our unit between April 2000 and May 2011 were reviewed. Diagnosis of DFSP was confirmed in all patients by biopsy. Patient demographics, along with clinical and surgical data, are summarized in Table I.

Results

During the last 2 decades, we have been treated 33 patients with DFSP using 3D histology surgery with paraffin sections. Four patients were excluded because of short follow-up (ie, <12 months). Of the 29 patients included in this study, 14 were female and 15 were male. Mean patient age was 40.7 years. As for tumor characteristic, 7 were located on the upper extremities, 15 on the trunk, 4 on the lower extremities, and 3 in the head and neck region (Table II). The mean average duration of tumor

Discussion

Traditionally, the mainstay of DFSP treatment has been surgical excision. However, because of the infiltrative growth that characterizes this kind of tumor, local recurrence after surgical excision tends to be high. In the past, for some authors wide local excision with negative margins was the optimal treatment. However, the optimal width of excision around the tumor has never been defined. and several series have been published with contradictory results.17, 18, 19 The classic recommendation

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  • Cited by (8)

    • 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

      2014, Journal of Plastic, Reconstructive and Aesthetic Surgery
      Citation Excerpt :

      The technique used by Farma et al. is a modified WLE procedure (CCPDMA) similar to the Modified/Slow Mohs procedure and may be more representative of this technique than that of traditional WLE (Figure 4).28 Similar techniques termed the ‘vertical modified technique’ used by Hersant et al. and ‘three-dimensional histology’ used by Irarrazaval et al. were recently reported.30,34 For MMS-treated patients, recent reviews of the literature show raw pooled data of these patients having a low recurrence rate approaching 1%.19,20

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    Funding sources: None.

    Conflicts of interest: None declared.

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