Is Mohs surgery the best option or the gold standard for re-excision of a rather small (2x2x2 cm at primary removal) DFSP on the back?
Mohs Surgery Best for Removing DFSP?
Doctor Answers 6
Mohs plus permanent section borders for DFSP.
Dermatofibrosarcoma Protuberans (DFSP) is an invasive and difficult tumor to remove. It is best to treat it with respect and first perform Mohs surgery with a qualified and very experienced Mohs surgeon, and then follow the Mohs clear margins with one extra layer to be processed for permanent sections with special stains at an outside lab, for definitive clearance.
Mohs is excellent for DFSP
DFSP is a less common type of skin cancer that often times spreads beyond what is seen on the skin surface and as a result has a higher recurrence rate than other common tumors.. Because of this, Mohs surgery is ideal for tracking these tumors as they spread through the tissues and minimizing the chance of recurrence.
Mohs surgery is the gold standard for dermatofibrosarcoma protuberans (DFSP)
Dermatofibrosarcoma protuberans otherwise known as DFSP clinically can be non-descript, such a brown bump on back or extremities. However, DFSP is typically quite insidious with very indistinct margins, even under microscope. Mohs micrographic surgery should be considered for DFSP as it is the best procedure to ensure clear margins with smallest defect possible.
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Mohs for DFSP
Yes. It is the gold standard as these neoplasms can involve the margins with standard excisions. Many Mohs surgeons often excise an additional layer of skin around the negative frozen section Mohs defect and submit it to a dermatopathology laboratory for permanent section analysis. Special stains may be performed to see if there are any residual cells at the margin. Some may even do these stains in their Mohs labs on frozen sections but they may be of the minority of Mohs surgeons. When Mohs is not possible, a wide excision is necessary involving many stepsections performed by the pathologist to determine margin clearance.
Mohs Surgery for DFSP
DermatoFibrosarcoma Protuberans (DFSP) is not as common as other skin cancers treated with Mohs Surgery. Mohs Surgery is an excellent option for this tumor because it can often extend beyond the visible clinical margin of the tumor. Historically DFSPs have had very high local recurrence rates. Because of the precise control removing the tumor Mohs Surgery is an excellent option.
Mohs surgery for DFSP
Good question. DFSP or dermatofibrosarcoma protuberans is a tumor that can send out long "tentacles." It is also a contiguous/continuous tumor which makes it amenable to Mohs surgery. Mohs surgery allows for excellent margin control and is in fact the best option for treating DFSP because it results in the highest cure rate.