DERMATOFIBROSARCOMA PROTUBERANS TREATED BY WIDE LOCAL EXCISION AND SITE-SPECIFIC RECONSTRUCTION: MARGIN STATUS AND RECURRENCE IN A TERTIARY-CARE CASE SERIES

Abstract

Background: Dermatofibrosarcoma protuberans (DFSP) is an uncommon dermal spindle-cell sarcoma characterized by deceptively indolent growth, irregular subclinical extension, and a clinically important tendency for local recurrence after inadequate excision. Although metastatic spread is rare, surgical morbidity may be considerable when tumors occur on the trunk, shoulder, or abdominal wall, where oncologic clearance creates large composite defects. Methods: We present a retrospective, CARE-informed case series of six histopathologically confirmed DFSP cases treated in the Department of General Surgery, JSS Medical College and Hospital, Mysuru, from January to December 2025. Patient demographics, duration of disease, previous excision, site, diagnostic work-up, operative technique, reconstruction, margin status, postoperative recovery, and early outcomes were extracted from available clinical and histopathology records. Results: A total of five men and one woman—all with a mean age of 63.3 years—constituted the cohort. Four tumors involved the anterior abdominal wall or lower chest wall; one arose over the right thigh; and one involved the right shoulder. Three had past excision. Patients were all treated by wide local excision with gross margins of 3–4 cm and deep clearance to the fascia, rectus sheath, skeletal muscle, or involved plane. Reconstruction was individualized: primary closure was adequate for the thigh lesion; mesh reinforcement or bridging was needed for abdominal-wall defects; and regional flap coverage with split-skin grafting was performed for shoulder and chest-wall defects. Histology reported spindle-cell proliferative DFSP with storiform, fascicular, sheet-like, or focally herringbone patterns and free margins where documented. No early wound, graft, flap, or mesh-related complication was recorded. Conclusion: This series highlights that DFSP management is primarily surgical but often reconstructive in practice. Wide excision with disciplined margin planning achieved early local control; however, long-term surveillance is essential because recurrence may be delayed and is strongly related to prior incomplete excision.