Date of Award

9-30-2010

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Deepak Narayan

Abstract

The purpose of this project was to design an algorithm for the management of Dermatofibrosarcom Protuberans (DFSP.) The National Cancer Center Network guidelines suggest immediate reconstruction in most cases after DFSP resection. We believe this algorithm is inadequate. Due to the infiltrating nature of DFSP, tumor margins are often positive after resection. Immediate reconstruction in the context of residual tumor is problematic because of the risk for spreading microscopic disease and the potential to compromise reconstructive options. At our institution we examined the prevalence of positive margins on permanent pathology after immediate closure following surgical resection of DFSP. Forty-one patients were identified; 25 had received treatment with surgical excision and 16 with Mohs surgery. Of the 25 patients that were treated with surgical excision, 20 underwent immediate closure and 5 underwent delayed closure after tumor resection. Eight out of 19 (40%) of patients who underwent immediate closure were found to have positive margins on permanent pathology. Given these findings, we propose a treatment algorithm focused on more conservative surgical management of DFSP in which negative margins are established before closure. Mohs surgery, which allows for immediate identification of pathology, plays a central role.

Comments

This is an Open Access Thesis.

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