Maximilian Gassenmaier, Erik Weber, Ulrike Leiter, Matthias Hahn, Stephan Forchhammer, Hans-Martin Häfner, Alexander Scheu, Claus Garbe, Saskia Schnabl
DOI: 10.2340/00015555-3915

Removal of the deep fascia is recommended in therapy for dermatofibrosarcoma protuberans, but its necessity in the context of micrographic surgery is unclear. A retrospective clinicopathological analysis of 48 patients with dermatofibrosarcoma protuberans treated by micrographic surgery was performed, to determine in which tumours fascia preservation was feasible and safe. Histologically, 93% of tumours on the trunk and extremities and 14% of tumours in the head and neck region were fully located above the fascia. Localization on the head and neck was the only significant risk factor for tumour extension beyond the subcutis (p<0.001). Overall, 44% of tumours were completely excised above the fascia and 56% with deeper excisions. Two deeply infiltrating tumours (4%) on the head recurred, but in none of these lesions was the fascia spared. These results show that micrographic surgery allows fascia preservation in superficial tumours outside the head and neck region.

Dermatofibrosarcoma protuberans is a rare, locally aggressive, cutaneous, soft tissue sarcoma. Excision of the deep fascia is recommended to achieve tumour clearance, but its necessity in the context of micrographic surgery is unclear. This study investigated 48 tumours excised with micrographic surgery at a tertiary referral centre to determine whether and for which tumours the preservation of the fascia is feasible and safe. The results showed that most dermatofibrosarcoma protuberans were completely epifascial in location, and that the infiltration depth depended on the tumour site. Fascia preservation in superficial dermatofibrosarcoma protuberans was not associated with an increased risk of recurrence.

Figure S1