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TOPLINE:

Mohs micrographic surgery (MMS) was associated with lower positive margins and cumulative recurrence rates than wide local excision (WLE) in a retrospective study of patients with dermatofibrosarcoma protuberans (DFSP).

METHODOLOGY:

• Researchers conducted a retrospective multicenter cohort study of 205 patients (mean age, 42.8 years; 40% male; 73.7% White; 3.9% immunosuppressed) with biopsy-proven DFSP treated at three academic centers in the US between January 2008 and March 2025.
• Of all patients, 47.8% had tumors with a diameter of at least 3 cm, 38.5% had invasion of fascia, muscle, or periosteum, and 13.7% of tumors were located on the head and neck.
• WLE was performed in 48.3% of patients, and MMS was performed in 51.2% of patients; the mean follow-up duration was 4.41 years.
• Researchers assessed postresection margin status and recurrence.

TAKEAWAY:

• Overall, 46 (22.4%) had positive margins and 9 (8.4%) had recurrence.
• Positive surgical margins occurred more often with WLE than with MMS (37.4% vs 8.6%; P < .001); WLE was associated with a significant risk for positive margins after adjustment for confounding factors (adjusted odds ratio [aOR], 5.99; P < .001).
• Head and neck tumors (aOR, 3.98; P = .003) and tumors with deeper invasion beyond subcutaneous fat (aOR, 2.45; P = .022) were independently associated with increased odds of positive margins.
• Five-year cumulative recurrence rates were 2.1% with MMS and 11.9% with WLE, with significantly improved recurrence-free survival observed with MMS.
• Five-year cumulative recurrence rates were lower with MMS than with WLE (2.1% vs 11.9%); recurrence‑free survival favored MMS after adjustment (P = .033).

IN PRACTICE:

“Tumors with deeper invasion, treated with WLE, or located on the head and neck were more likely to have positive margins, highlighting challenges of complete resection in anatomically complex areas,” the authors wrote. Lower recurrence with MMS “highlights the importance of initial margin control,” they added, but “WLE remains an acceptable treatment option when MMS is not available.” 

SOURCE:

The study was led by Bina Kassamali, MD, and Catherine E. Pisano, MD, Department of Dermatology, Brigham and Women’s Faulkner Hospital, Boston, and was published online in a research letter on May 22 in the Journal of the European Academy of Dermatology and Venereology.

LIMITATIONS:

The study limitations included its retrospective design and potential selection bias.

DISCLOSURES:

The study did not receive any funding. Some authors declared serving as investigators, consultants, advisors, and executive officers for various companies including Sol-Gel Technologies, Castle Biosciences, Merck, and Regeneron. Full disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.