Scholar: Raashid Hamid
Guide:
Aadil Hafeez; Baba, Khalil*, Darzi, Mohammad Ashraf
Title: Clinical profile and outcome of surgical treatment of
dermatofibrosarcoma protuberans (DFSP).
Keywords: Dermatofibrosarcoma Protuberans-Surgery;
Dermatofibrosarcoma Protuberans-Treatment
Degree: M.S
Year:
2009
Institution: Dept of Plastic & Reconstructive Surgery, and
*Dept of Pathology,
Sher-i-Kashmir Institute of Medical Sciences..
Abstract
Objectives: The main objective of the present study was to study the clinical pattern and
outcome of surgical treatment of Dermatofibrosarcoma Protuberans.
Material & Methods: This study included 45 patients both retrospective and prospective
from Dec. 1995 to Dec. 2008.
Results: In total, 45 patients were studied. Out of 45 patients, 30 were males and 15
females with the male to female ratio of 2:1. Mean age of presentation was 38.4±13.2
years. Commonest mode of presentation was raised firm multinodular lesion with fixity
to overlying skin. Site distribution was 42.22% trunk, 58.88% extremities and head &
neck. All the patients underwent wide local excision. Split thickness skin graft (STSG)
was used in 37 (82.22%), pedicled flap in 3 (6.66%) & primary closure in 5 patients. On
histological examination, 8 patients had positive margins and adjuvant post operative
radiotherapy was used in these 8 patients. The rate of recurrence following surgery was
18.91% and after adjuvant postoperative radiotherapy, recurrence rate was 37.50%.
Overall recurrence rate was 22.22%. Only 2 patients developed metastasis to lungs in the
course of their follow-up. None of the patients had lymph node involvement. Out of 45
patients, 35 remained recurrence free over a varying period of 5 months to 13 years
(mean 68 months). 10 patients developed one or more local recurrences. Out of 10
patients with local recurrence, 7 had single recurrence, 1 had 2 recurrences and 2 had
more than 2 recurrences. Average time from initial treatment to recurrence was 32
months. All patients with recurrent tumours were subjected to salvage treatment i. E. reexcision. Average recurrence free period was 36±44 months within a mean follow up of
68 months.
Conclusions: Because of the potential of local recurrence, therapy for DFSP should be
directed towards adequate local excision of the primary lesion. Minimal resection should
include a surrounding margin of 2-3cm of normal skin. and removal of underlying deep
fascia is essential. Compromising on margins invites higher chances of local recurrence.
Addition of adjuvant postoperative radiotherapy may decrease likelihood of local
recurrence.