Mohs Micrographic Surgery for Dermatofibrosarcoma Protuberans of the Vulva

Introduction. Dermatofibrosarcoma Protuberans (DFSP) is a rare cutaneous tumour of low/intermediate malignant potential, which occasionally arises on the vulva. Historically, the treatment has been wide local excision (WLE). Mohs micrographic surgery (MMS) is now recommended to ensure precise margin control. MMS to treat DFSP of the trunk and extremities is well documented. However, no report to date has described its use in vulval DFSP.Case History. A 39 year old woman presented with a longstanding nodule in the left labium majus. Histology after surgical removal showed an incompletely excised DFSP. MMS was undertaken with primary closure of the defect. Three years following treatment there is no evidence of recurrence.Discussion. The local recurrence rate of DFSP after WLE ranges from 0–75%. Finger-like projections from DFSP into surrounding tissue often results in incomplete excision. Representative vertical sections used in WLE assess less than 1% of the total tumour margin. MMS uses systematic horizontal sectioning. 100% of the tumour margin is microscopically examined. MMS is now advocated to ensure precise margin control.

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Autoamputation of Dermatofibrosarcoma Protuberans: A Novel and Rare Presentation of a Familiar Entity

International Journal of Surgical Pathology ◽

10.1177/1066896919832658 ◽

2019 ◽

Vol 27 (5) ◽

pp. 531-534

Author(s):

Judith Jebastin Thangaiah ◽

Sean R. Williamson ◽

Jason Pimentel ◽

Kyle Perry

Keyword(s):

Local Recurrence ◽

English Literature ◽

Significant Risk ◽

Dermatofibrosarcoma Protuberans ◽

Malignant Potential ◽

Mohs Micrographic Surgery ◽

Micrographic Surgery ◽

Rare Presentation ◽

Accelerated Growth ◽

Dermal Lesion

Dermatofibrosarcoma protuberans (DFSP) is categorized as a fibrohistiocytic tumor of intermediate malignant potential. It has significant risk for local recurrence and, less commonly, local or distant metastasis. Initially, these tumors typically arise as a firm plaque on the skin that slowly progresses to a nodular and protuberant dermal lesion. DFSP can also exhibit ulceration, hemorrhage, and accelerated growth, but autoamputation has not been described in the English literature. In this article, we report a case of an asymptomatic classical DFSP on the upper back in which the protuberant portion spontaneously autoamputated. In this case, the residual lesion was treated with Mohs micrographic surgery. The presentation, features, and implications of this interesting mode of presentation are discussed.

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Dermatofibrosarcoma Protuberans Growing Around Plantar Aponeurosis: Excision by Mohs Micrographic Surgery

Dermatologic Surgery ◽

10.1046/j.1524-4725.2000.026010941.x ◽

2000 ◽

Vol 26 (10) ◽

pp. 941-945 ◽

Cited By ~ 13

Author(s):

Gregory J. Kricorian ◽

Carl F. Schanbacher ◽

Paul A. Kelly ◽

Richard G. Bennett

Keyword(s):

Dermatofibrosarcoma Protuberans ◽

Mohs Micrographic Surgery ◽

Micrographic Surgery ◽

Plantar Aponeurosis

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Dermatofibrosarcoma Protuberans in Childhood Treated with Slow Mohs Micrographic Surgery

Pediatric Dermatology ◽

10.1111/pde.12039 ◽

2013 ◽

Vol 30 (4) ◽

pp. 462-468 ◽

Cited By ~ 7

Author(s):

Marjam J. Barysch ◽

Lisa Weibel ◽

Kathrin Neuhaus ◽

Ulrike Subotic ◽

Leo Schärer ◽

...

Keyword(s):

Dermatofibrosarcoma Protuberans ◽

Mohs Micrographic Surgery ◽

Micrographic Surgery

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Mohs Micrographic Surgery Peripheral Margin Control Prior to En Bloc Tumor Resection: A Report of Three Cases

SKIN The Journal of Cutaneous Medicine ◽

10.25251/skin.2.1.7 ◽

2018 ◽

Vol 2 (1) ◽

pp. 49-53

Author(s):

Daniel Bernstein ◽

Sara Giddings ◽

Hooman Khorasani

Keyword(s):

Plastic Surgery ◽

Tumor Resection ◽

Mohs Micrographic Surgery ◽

Micrographic Surgery ◽

En Bloc ◽

Facial Plastic Surgery ◽

Facial Plastic ◽

Tumor Extirpation ◽

The Right ◽

Margin Control

Background: Mohs micrographic surgery (MMS) is an important part of non-melanoma skin cancer (NMSC) management but may even be useful for tumors that cannot be cleared in an office setting. There are sparse reports of MMS for peripheral margin control in the dermatology literature but various techniques have been reported.Case 1: 58-year-old male with morpheaform basal cell carcinoma of the left midface treated with MMS peripheral margin control followed by facial plastic surgery central tumor extirpation and defect repair.Case 2: 56-year-old female with recurrent morpheaform BCC of the scalp treated with MMS peripheral margin control followed by facial plastic surgery central tumor extirpation and defect repair.Case 3: 73-year-old male with multiply recurrent SCC of the right lower extremity treated with MMS peripheral margin control followed by above the knee amputation.Conclusions: MMS peripheral margin control followed by central tumor extirpation and defect reconstruction at a later date in the operating room is an option for deeply invasive, large and aggressive NMSC. Benefits include decreased time under general anesthesia and superior rates of tumor clearance. In the interim, the peripheral defect between the central tumor and healthy outer tissue can be sutured closed to decrease patient morbidity.

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