Combined Wide Excision, Mohs Micrography, and Reconstruction of Recurrent Dermatofibrosarcoma Protuberans

Both the wide deep local excision and Mohs micrographic surgery are standard treatment for Dermatofibrosarcoma (DFSP).This report aims to evaluate the association of these two surgical policies with immediate reconstruction of the defect by a distant flap for treating large repeatedly recurrent DFSP.An adult patient presented with a 10x12 cm DFSP on the neck anterior surface and another with an 11x25 cm DFSP on the chest right side.They underwent excision of the tumor entire lesion with 2-4 cm safety margins including the apparently healthy underlaying tissue layer associated with frozen sections testing of the defect periphery and floor.The regularly advisable reconstruction by split-thickness skin grafting for easy detection of recurrence could not be performed because it would have end with cervical skin shortening contractures in one patient and would not have survived on bare clavicular bone in the other.An island latissimus dorsi musculocutaneous flap ensured satisfactory functional and aesthetic results.Hematoxylin and eosin-stained tissues reported peripheral mass free from residual tumor.Follow-up of 18 months in the first case and 12 months in the second case did not show recurrence.