DFSP about 18yrs ago, in the web space between baby and ring finger on hand. I had tumour removed and the web space that was involved. I was left with a scar lump witch is just latley been tender to the touch. I am assuming DFSP has returned. The surgeon in 1992 said at the time I would have been better to amputate the last two fingers and a good portion of the palm. Of course would like to find an alternative solution. Given the position of this DFSP, would a Mohs be recomended?
I Have a DFSP on the Base of the Ring Finger, Would the Mohs Be the Best Option for Me?
Doctor Answers (4)
DFSP of the hand
Please do get a biopsy to discover if this is a recurrent DFSP or hypertrophic scar. If it does come back as scar, make sure the biopsy was adequate so the dermatopathologist, who should be reading the slide, has enough tissue to make the best diagnosis. Furthermore, you may need a second dermatopathological opinion of the biopsy, or a rebiopsy. If a diagnosis of DFSP is made, Mohs surgery is still worthwhile to improve the chance of cure but a consultation with a reconstructive hand surgeon should be done prior to the Mohs surgery so that communication between the surgeons facilitates scheduling of the reconstruction quickly after the MOhs. There is a chance of recurrence with wide amputation or Mohs, but the MOhs has the best chance of not leaving some DFSP behind.
DFSP (Dermatofibrosarcoma protuberans) a rare skin cancer and Mohs micrographic surgery
Dermatofibrosarcoma protuberans or DFSP is a rare skin neoplasm that can be insidious to diagnose and difficult to eradicate. Given the margins are difficult to define clinically and histologically, Mohs micrographic surgery would be the gold standard to ensure cure and minimize unnecessary removal of healthy tissue. Whenever you have a scar tissue that changes in shape, size, color, or symptoms such as itching or bleeding, have it be evaluated by a board-certified dermatologist.
Mohs for dfsp?
Mohs is a great option for this type of rare skin cancer. It is notorious for recurrence, and often infiltrates deeper than it might appear. Sometimes, because the defect following Mohs can be quite large and irregular, coordination with plastics could be necessary. I do agree that biopsy confirmation must be obtained prior to Mohs.
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Have the area reevaluated by a dermatolgist first...
First off, I would have the lump reevaluated by a dermatologist. He or she will most likely take a biopsy to confirm if the DFSP has come back or not. It could be a hypertrophic scar.
Now if the lesion is indeed a DFSP, I would highly recommend Mohs micrographic surgery, as it is tissue sparing and will evaluate the complete margins to minimize the chance of recurrence. There are several journal articles out there that now claim Mohs as the treatment of choice for DFSP. Sometimes in really extensive DFSP, there has also been good response to a chemotherapy drug called Gleevac. I would definitely do Mohs before consider the amputation option.
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