Surgical margins for excision of dermatofibrosarcoma protuberans.

Abstract

Dermatofibrosarcoma protuberans (DFSP) commonly recurs after standard surgical excision with a wide margin. No studies have been undertaken to objectively determine the appropriate surgical margins by measuring the extension of the subclinical tumor. Our purpose was to measure the subclinical extent of tumor in 20 patients with DFSP to determine appropriate surgical margins. We mapped the subclinical tumor extension with Mohs micrographic surgery and measured the surgical margins required to clear the tumor completely. We found that a 2.5 cm surgical margin through the deep fascia (nonscalp) or periosteum (scalp) cleared all of the tumors. DFSP tumors that measured less than 2 cm were completely cleared with a 1.5 cm surgical margin. None of our patients had a recurrence of the tumor, and in 16 of 20 patients repairs were possible. Our data support the use of Mohs surgery to excise DFSP with maximum conservation of tissue and a high cure rate.