Are All Mohs Surgeon Qualified to Deal with DFSP Tumor?
- Asked by Hope for a cure in Raleigh NC
- 4 years ago
Who is the most qualified MOHS surgeon that can deal with DFSP (Dermatofibrosarcoma Protuberan) on the face?
Hi, I had a MOHS surgery on my face to remove a DFSP tumor about 2 years ago. The surgeon missed to reove one piece of tissue under my nose that I felt was DFSP.
This week, my surgeon went to the same place and had a biopsy and found out that the tissue I was talking about was DFSP.
Should I seek a second opinion or should I find a specialist that deals with this type of cancer? Thanks Thanks
Who is most qualified to treat DFSP
Fellowship-trained Mohs surgeon are recognized as the experts in skin cancer management. To be a fellowship-trained Mohs surgeon requires a year long training period after board certification in Dermatology in what is called cutaneous (skin) oncology (study of cancer). As part of becoming certified the fellowship trained Mohs surgeon is required to perform over 500 Mohs cases in the year, perform complex reconstruction with grafts or flaps of the surgical sites, and manage complex tumors which would include DFSP. That being said, a DFSP of the face is a fairly rare tumor and so you can then further search out whether your Mohs surgeon is not only part of the American College of Mohs Surgery ACMS (this is not the same as the American Society of Mohs Surgery although the names are similar), Then once you have confirmed memebrship in the College ask them how many of these have they done. I have personally performed over 10 cases like yours and although this does not sound like a lot , for a rare tumor such as a DFSP it is more than most. That being said, if your Mohs surgeon has perfomed over 3 or 4 then they may be the closest thing to an expert you will find. Since you are in Raleigh NC you should be able to find a Mohs surgeon at Duke that has experience with your type of cancer or at least know where you can find one locally. Start wiht Jonathon Cook at Duke.
DFSP is a rare tumor
DFSP is a fairly rare tumor. Experience of the Mohs surgeon is going to be very important. Academic centers are more likely to encounter DFSP's on a regular basis. It is important that you find a Mohs surgeon who has been trained in a fellowship. These individuals have seen the volume of cases necessary to encounter DFSP.
Because DFSP can have quite a bit of tumor extension (fingers of tumor growing under the skin), you may require a significant reconstruction since this is on your face. It may be worthwhile to take a multidisplinary approach and involve a facial plastic surgeon as well. Another possibilty is considering consultation with an oncologist. Gleevac has been shown to shrink DFSP. Depending upon the size of your tumor, it may be worth considering in addition to Mohs surgery.
DFSP and Mohs
Dear Hope for a cure,
DFSP is a notoriously difficult tumor to treat. First, because it is an aggressive tumor and second, because it recurs often. Mohs is the best way to go because it is a tissue sparing technique (the surgeon can look at the tissue while you wait).
Given the location, you may want to go to a place where the DFSP can be cleared with Mohs and then you can have facial plastics reconstruction. The problem is that few people will flap an area of DFSP because it can hide recurrence so your repair options may be limited. It will be difficult to find a Mohs surgeon who has done "a lot" of DFSP because in general, it is a rare tumor and even more rarely occurs on the face (typically it is on the trunk).
You may consider an academic center in your area or speak openly about your concern with your Mohs surgeon.
Best of luck,
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Dermatofibrosarcoma Protuberans characteristically behaves more aggressively each time it recurs. One of the problems of having this lesion on your face is common to skin cancer in general. That is, the surgeon is more reluctant to take a wide margin.
Moh's has become increasingly utilized as a treatment for DFSP. Many Moh's Surgeons like to do what is called "slow Moh's". They combine the benefits of frozen sections ( slides are made from fresh tissue at the time of excision) and Moh's. This may be advised in your situation. After the tumor has been extirpated, it is generally advised to take an extra margin for additional safety.
My advice would be to find a Moh's Surgeon who has treated a number of DFSP cases using Moh's. . You might ask your Moh's surgeon whether he is one of these people. He will most likely give you an honest answer. DFSP is notoriously tricky the second time around as tumor can masquerade as scar tissue. He/she may not want to deal with it.
Alternatively, if you care less about your physician appearance, you might opt for a facial surgeon who has treated a number of DFSP cases. The main advantage of Moh's is that it is tissue sparing. If you care less about your subsequent appearance, you might seek a facial surgeon and forget the Moh's approach.
Good luck. You have a tough choice.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.