Impact of Dermatology Access on Dermatofibrosarcoma Protuberans Outcomes: A Retrospective Study in a Larger Cohort.

Abstract

Introduction: Dermatofibrosarcoma protuberans (DFSP) is an aggressive rare cutaneous tumor with a relatively high rate of local recurrence. Incidence in the United States has been reported around 4 occurrences per million people per year. Local recurrences have been reported between 2 to 19% of cases. These cases are at higher risk for sarcomatous transformation, increasing the risk for metastasis. Early and accurate diagnosis, coupled with appropriate management, is essential to minimize these risks. However, early on, DFSP is often misdiagnosed as a number of benign subcutaneous growths. Misdiagnosis often leads to incorrect or delayed treatment. This study extends previous research by evaluating whether access to dermatology care influences DFSP treatment outcomes in a larger cohort and larger geographical area.

Methods: This study is a retrospective review currently including 68 adults with histologically confirmed DFSP. The study evaluated three endpoints: rates of appropriate workup and diagnosis comparing dermatology and non-dermatology providers, rates of appropriate primary treatment between lesions with and without appropriate workup and diagnosis, and rates of positive margins or primary recurrence between lesions without and with appropriate primary treatment.

Results: For all three endpoints, the data rejected the null hypothesis.

Conclusion: These findings further support that early biopsy and high clinical suspicion for DFSP improve surgical outcomes, particularly when diagnostic biopsy is performed prior to treatment. The larger sample size reinforces the importance of dermatology access in optimizing patient care and decreasing morbidity from DFSP treatment. Increased clinical awareness and stricter adherence to diagnostic and therapeutic guidelines are recommended for improved patient outcomes in the management of DFSP.