Mohs micrographic surgery for dermatofibrosarcoma protuberans: our experience using frozen sections and a literature review.

Abstract

Introduction and objectives: Mohs micrographic surgery (MMS) is considered the gold standard for the treatment of dermatofibrosarcoma protuberans (DFSP). Although paraffin-based MMS is the most widely accepted technique, no study has demonstrated its superiority over frozen-section MMS. We present our experience with frozen-section MMS for DFSP and review the literature.

Materials and methods: We conducted a retrospective, observational, single-center study of all patients with DFSP treated with frozen-section MMS between July 2014 and July 2023. Demographic and tumor characteristics, surgical characteristics, and clinical outcomes were analyzed.

Results: Twenty-nine patients were included (72.4% female; median age, 46 years). DFSP was most commonly located on the back (27.6%), upper extremities (24.1%), and lower extremities (24.1%). The median preoperative tumor size was 4.5 cm, and the median postoperative defect size was 6.3 cm. Surgical defects were repaired by direct closure in 75% of cases. Two patients experienced postoperative complications. No recurrences were recorded after a median follow-up of 74 months. The median number of MMS stages required was 2 and was significantly higher for tumors located on the extremities (P = .038).

Conclusions: We present a series of 29 patients with DFSP treated with frozen-section MMS, with no recurrences after a median follow-up of 74 months. These findings provide additional evidence of the effectiveness and characteristics of this technique. We consider frozen-section MMS a suitable treatment option for DFSP.