Clinical, Histopathologic, and Surgical Aspects of Dermatofibrosarcoma Protuberans on the Head vs Other Locations: Retrospective Single-Center Case Series of 235 Tumors

fx1 Background: Dermatofibrosarcoma protuberans (DFSP) is a rare tumor that affects the head in 10% to 15% of cases. Head DFSP is often associated with more complex surgery and a higher rate of local recurrence. Objective: To compare the clinical, histopathologic, and surgical characteristics of head DFSP vs body DFSP in order to identify potential risk factors. Methods: Retrospective study. Results: Of 235 DFSP, 32 (13.6%) were located on the head. Histologically, 71.0% of head DFSP vs 7.4% of body DFSP were purely subcutaneous with no dermal involvement (P < .001). Tumor infiltration of the superficial muscle and/or periosteum was observed in 81.4% of head tumors vs 18.7% of body tumors (P < .001). Focal muscle involvement was present in 90.0% of facial DFSP, and periosteal involvement was present in 50.0% of scalp DFSP. Two or more stages of modified Mohs surgery were required in 71.0% of head DFSP vs 35.9% of body DFSP (P = .002). After a mean follow-up of 6.7 years, recurrences were significantly more common in head DFSP (3/32, 9.4% vs 3/203, 1.5%; P = .035). Head tumors recurred significantly later than body tumors (mean, 7.2 vs 1.5 years; P < .001). Limitations: Retrospective design. Conclusions: Head DFSP is typically subcutaneous and often focally infiltrates the superficial muscle in facial lesions and the periosteum in scalp lesions. Longer follow-up for head DFSP is advisable.