Key result
Mohs micrographic surgery achieved complete tumor excision with clear margins after two stages in a 70-year-old woman with dermatofibrosarcoma protuberans, with no recurrence at 9 months.
Why the study?
Dermatofibrosarcoma protuberans typically arises in younger to middle-aged adults, while patient age 60 years or older and larger tumor sizes are associated with worse survival.
Case Report (n=1)
No
This case highlights the successful use of Mohs micrographic surgery for dermatofibrosarcoma protuberans in an older adult, emphasizing the need for early biopsy and molecular confirmation.
Dermatofibrosarcoma protuberans (DFSP) is a rare, low-grade soft tissue sarcoma. It typically arises in younger to middle-aged adults, while patient age ≥60 years and larger tumor sizes are associated with worse overall and cancer-specific survival. We present the case of a 70-year-old woman with a one-year history of a progressively enlarging, tender erythematous plaque on the left clavicle. Differential diagnosis included dermatofibroma, DFSP, leiomyoma, cutaneous leiomyosarcoma, cutaneous lymphoma, and leukemia cutis. Punch biopsy revealed a CD34-positive spindle cell neoplasm, and fluorescence in situ hybridization confirmed COL1A1 rearrangement, consistent with DFSP. The patient underwent Mohs micrographic surgery, with clear margins achieved after two stages. This case highlights an atypical age of presentation and reinforces the importance of early biopsy and molecular confirmation for accurate diagnosis. Mohs micrographic surgery remains the preferred treatment, offering precise tumor margin control and minimizing recurrence risk compared to wide local excision, while systemic options such as imatinib are reserved for unresectable or metastatic disease. Early recognition and intervention are especially critical in older patients, given their higher risk of adverse outcomes.
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Peng et al. (2025) conducted a case report in Dermatofibrosarcoma Protuberans (n=1). Mohs micrographic surgery was evaluated on Tumor-free margins. Mohs micrographic surgery achieved complete tumor excision with clear margins after two stages in a 70-year-old woman with dermatofibrosarcoma protuberans, with no recurrence at 9 months.
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