Skip to main content

Dermatofibrosarcoma Protuberans: Reappraisal of Wide Local Excision and Impact of Inadequate Initial Treatment


Background: The extent of local invasion in dermatofibrosarcoma protuberans (DFSP) is often clinically difficult to appreciate, and this leads to inadequate resections. We examined the effect of inadequate initial treatment and the efficacy of wide resection.

Methods: We performed a retrospective analysis of the records of 35 patients with DFSP treated at our institution (1985 and 2001). Data were analyzed with Wilcoxon’s ranked sum test and Fisher’s exact test.

Results: Of the 24 patients eligible for analysis, 11 had definitive wide resection after diagnostic excisions elsewhere (primary group), and 13 had recurrent tumors after previous surgical treatment elsewhere (recurrent group). Twenty-three patients were treated with wide resection only, and adjuvant radiation was administered to one patient who had a fibrosarcoma. At a median follow-up of 54 months, patients definitively treated at our institution had a 100% local recurrence–free survival. In comparison to the primary group, recurrent DFSPs were significantly larger and deeper and occurred in the head and neck region. Five cases had bone involvement, and of these, 80% occurred in the recurrent group.

Conclusions: Inadequate initial treatment results in larger, deeper recurrent lesions, but these can be managed by appropriate wide excision. Wide resection of DFSP (whether recurrent or primary) with negative histological margins predicts a superior local recurrence–free survival.

This is a preview of subscription content, access via your institution.


  1. 1.

    Darrier J, Ferrand M. Dermatofibromes progressifs et recidivants ou fibrosarcomas de la peau. Ann Dermatol Syphiligr (Paris) 1924;5:545–62.

    Google Scholar 

  2. 2.

    Hoffman E. Uber das knollentreibende fibrosarkom de haut. Dermatol Z 1925;43:1–28.

    Article  Google Scholar 

  3. 3.

    Mentzel T, Beham A, Katenkamp D, Dei Tos AP, Fletcher CD. Fibrosarcomatous (“high-grade”) dermatofibrosarcoma protuberans: clinicopathologic and immunohistochemical study of a series of 41 cases with emphasis on prognostic significance. Am J Surg Pathol 1998;22:576–87.

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Bowne WB, Antonescu CR, Leung DH, et al. Dermatofibrosarcoma protuberans: a clinicopathologic analysis of patients treated and followed at a single institution. Cancer 2000;88:2711–20.

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Diaz-Cascajo C, Weyers W, Rey-Lopez A, Borghi S. Deep dermatofibrosarcoma protuberans: a subcutaneous variant. Histopathology 1998;32:552–5.

    PubMed  CAS  Google Scholar 

  6. 6.

    Lindner NJ, Scarborough MT, Powell GJ, Spanier S, Enneking WF. Revision surgery in dermatofibrosarcoma protuberans of the trunk and extremities. Eur J Surg Oncol 1999;25:392–7.

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Taylor HB, Helwig EB. Dermatofibrosarcoma protuberans: a study of 115 cases. Cancer 1962;15:717–25.

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Gloster HM Jr, Harris KR, Roenigk RK. A comparison between Mohs micrographic surgery and wide surgical excision for the treatment of dermatofibrosarcoma protuberans. J Am Acad Dermatol 1996;35:82–7.

    PubMed  Article  Google Scholar 

  9. 9.

    Rutgers EJ, Kroon BB, Albus-Lutter CE, Gortzak E. Dermatofibrosarcoma protuberans: treatment and prognosis. Eur J Surg Oncol 1992;18:241–8.

    PubMed  CAS  Google Scholar 

  10. 10.

    Stojadinovic A, Karpoff HM, Antonescu CR, et al. Dermatofibrosarcoma protuberans of the head and neck. Ann Surg Oncol 2000;7:696–704.

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Pack G, Tabah G. Dermatofibrosarcoma protuberans: a report of thirty nine cases. Arch Surg 1951;62:391–411.

    CAS  Google Scholar 

  12. 12.

    Lal P, Sharma R, Mohan H, Sekhon MS. Dermatofibrosarcoma protuberans metastasizing to lymph nodes: a case report and review of literature. J Surg Oncol 1999;72:178–80.

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Ratner D, Thomas CO, Johnson TM, et al. Mohs micrographic surgery for the treatment of dermatofibrosarcoma protuberans. Results of a multiinstitutional series with an analysis of the extent of microscopic spread. J Am Acad Dermatol 1997;37:600–13.

    PubMed  Article  CAS  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Vijay P. Khatri MD.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Khatri, V.P., Galante, J.M., Bold, R.J. et al. Dermatofibrosarcoma Protuberans: Reappraisal of Wide Local Excision and Impact of Inadequate Initial Treatment. Ann Surg Oncol 10, 1118–1122 (2003).

Download citation

Key Words

  • Sarcoma
  • Surgery
  • Margins
  • Recurrence