Surgical Management of Dermatofibrosarcoma Protuberans

Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive skin cancer that grows in the dermis. While it rarely spreads to distant sites, incomplete removal often leads to recurrence, making complete surgical removal essential. The two main techniques are wide local excision (WLE) and Mohs micrographic surgery (MMS). WLE has historically been the standard, but it carries higher recurrence rates. MMS, which examines nearly all surgical margins during surgery, has demonstrated superior local control—recurrence rates as low as 3% compared to over 30% with WLE. A variation, slow-Mohs, uses special stains for clearer evaluation of tumor edges and has shown excellent outcomes, though it is more time-intensive and costly. NCCN guidelines now recommend MMS (or slow-Mohs) as first-line treatment, with WLE reserved for cases where MMS is not available. The choice depends on tumor size, location, and surgical expertise, with MMS favored for smaller tumors and cosmetically sensitive areas.

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