Wide local excision vs Mohs Tübingen technique in the treatment of Dermatofibrosarcoma Protuberans: A two- centre retrospective study and literature review

Abstract

Background

Dermatofibrosarcoma Protuberans is a rare, low-grade mesenchymal skin tumour, characterized by slow infiltrative growth and common local recurrence, with infrequent distant metastases.

Objective

The aim of this study is to better clarify clinico-pathological characteristics of this tumour and to evaluate the cure rates of Mohs Tübingen technique (MTT) and wide local excision. Eventually, we perform a literature review to compare our experience with published data.

Methods

A retrospective review was conducted on 135 patients diagnosed, treated and followed-up between 1997 and 2014 at two different institutions. Sixty-two patients underwent to wide local excision and 73 to MTT. The primary end-points were: percentage of recurrences, time-to-progression and recurrence annual risk rate. Then, the PubMed database was searched for Dermatofibrosarcoma Protuberans case series treated with standard surgical resection, wide local excision, Mohs micrographic surgery and MTT. The annual risk rate of recurrence calculated and reported for the four separate procedures, was pooled to compare them.

Results

Five out the 62 patients with wide local excision (8.1%) experienced recurrences after a mean follow-up of 4.7 years; the percentage of recurred patients 9 years after MTT was 5.5%, and the annual recurrence risk rate of 0.6%. Pooling these data with those from literature, the recurrence rate varies from 26% to 60% for standard surgical resection, from 0 and 41% for wide local excision, from 0 and 8,3% for Mohs micrographic surgery and from 0 to 5.5%. for MTT. The lowest annual recurrence risk rate was found for MTT.

Conclusion

Significantly lower recurrence rates were recorded in patients treated with classic or Tübingen Mohs technique. To the best of our knowledge, our case series is the widest treated with MTT ever described in the literature; these data may be useful to guide clinicians in the choice of the gold standard treatment for Dermatofibrosarcoma Protuberans.

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