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Dermatofibrosarcoma protuberans: slow Mohs procedures in the diagnostic laboratory

Mohs surgical procedures are achieving greater prominence in the clinical management of a range of skin tumours. Here, in focusing on one lesion, Guy Orchard and Mohammed Shams outline an optimal complementary laboratory method.

Dermatofibrosarcoma protuberans (DFSP) is a rare superficial sarcoma which is believed to be of fibroblastic or myofibroblastic derivation. It is believed to have been first described as a progressive and recurring dermatofibroma by Darier and Ferrand in 1924, and Hoffman is generally recognised for officially coining the term dermatofibrosarcoma protuberans in 1925.1 The tumour is of an intermediate- to low-grade type. Although metastasis is rare, it invades locally and has a high recurrence rate. The tumour is commonly found within the dermis but it can invade deep into the subcutis, infiltrating the fatty tissue mainly via the fibrous septa between the adipocytes.

Conventionally, surgical removal represents the treatment of choice, ensuring margins of 3 cm or more of clinically uninvolved skin and underlying fascia. These tumours can expand to relatively large size and, if arising on the head and neck, can result in disfiguring and problematic reconstruction following removal.

Mohs micrographic surgery is widely employed for the removal of more conventional tumours (eg basal cell carcinoma) because of established improved cure rates over conventional surgical removal, maximal conservation of normal uninvolved tissue, and often an improved overall cosmetic result. However, the single significant positive indicator for the use of a Mohs procedure is that it enables the examination of the entire surgical margin, a facility not afforded by any other surgical procedure currently available. More recently, its popularity as a treatment for DFSP has been championed.

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Upcoming Events

USCAP 113th Annual Meeting

Baltimore Convention Center, Baltimore, Maryland, USA
23-28 March, 2024

Pathology Horizons 2024

MacDonald Bath Spa Hotel, Bath
18-20 April, 2024

Diagnostics North East Conference 2024

The Catalyst, Newcastle upon Tyne
19 April, 2024

ECCMID 2024 - European Congress of Clinical Microbiology and Infectious Diseases

Fira Gran Via, 08038 Barcelona, Spain
27-30 April 2024

British Society for Microbial Technology Annual Microbiology Conference

UK Health Security Agency, Colindale, London
2 May 2024

EQA Reports: Interpreting Key Information & Troubleshooting Tips

ONLINE - Zoom
Thursday 16th May 2024

Access the latest issue of Pathology In Practice on your mobile device together with an archive of back issues.

Download the FREE Pathology In Practice app from your device's App store

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