Surgical treatment of Darier-Ferrand dermatofibrosarcoma: a systematic review

Abstract

Background: Wide-excision surgery is required in Darier-Ferrand dermatofibrosarcoma protuberans, but there is no consensus regarding the lateral margins.

Materials and methods: We performed a systematic review based on a MEDLINE search of articles, published from 1994 to 2009 to determine the optimal procedure to avoid recurrences and treatment morbidity.

Results: The analyzed articles included five meta-analyses of retrospective studies; three prospective, nonrandomized studies; and 35 retrospective studies.

Discussion: Positive deep margins may lead to a recurrence independent of lateral margin status. Despite an absence of formal evidence, wide excision with 3-cm margins appears to result in significantly less risk of a recurrence than surgery using <3-cm margins. Negative histologic margins appear to be the best criterion to decrease recurrence. Despite a lack of strong data, there was a marked tendency of Mohs micrographic surgery (MMS) to produce better results than conventional surgery. If MMS is unavailable, surgery using 3-cm lateral margins and a disease-free anatomic zone deep into the lesion is proposed. Slow Mohs could be a safe alternative to MMS when the latter technique is not available. Patients should be followed for a minimum of 10 years and preferably indefinitely.