An experience of slow-Mohs micrographic surgery for the treatment of Dermatofibrosarcoma protuberans: A long-term cohort study.

Abstract

Dermatofibrosarcoma protuberans (DFSP) is a rare dermal mesenchymal tumor known as a low-grade, slow-growing malignancy. The local invasion and high rate of recurrence following surgical treatment are the main concerns to plan the best surgical approach of treatment. In the current study, it is aimed to provide an experience of slow-Mohs surgery for the treatment of patients with DSFP. Number of 25 patients with the diagnosis of DFSP through histological and immunostaining study was included. The slow-Mohs was performed by excision of the tumor with margins accounting for 1-2cm from both the tumor margins and three-dimensional thickness. The obtained tissue margins were horizontally, and if any of the specimens was not margin-free, the procedure was repeated. The patients' opinion about the procedure was assessed using Patient-Observer Scar Assessment Scale (POSAS). Number of 25 patients were included and followed for a median of 46.9 months. The median of the area of excision was 35.56cm2 , and the median clinical excision margins were 19mm (tumor excision margins + thickness of the three-dimensional excision). The surgery was performed once for 16 (64%), and postoperative skin closure within 5-7days after the procedure was performed for 19 (76%) patients. None of the patients represented any recurrence. The patients' overall opinion and satisfaction POSAS score accounted for 2.3±1.65 and 1.6±0.59, respectively. The findings of the current study are in favor of slow-Mohs surgery for the management of DFSP, while more extensive studies are strongly recommended for generalization of this procedure.