Recurrent Dermatofibrosarcoma Protuberans Over the Face: A Challenging Clinical Problem

Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive skin malignancy known for its high recurrence rate. It predominantly affects the trunk and extremities but can occasionally present on the face. A 47-year-old man presented with a rapidly progressive, painless swelling on the left side of his face for six months. The swelling, measuring 5x4x2 cm, was well-defined, bosselated, mobile, and firm. MRI revealed a well-defined subcutaneous lesion in the left infraorbital and premaxilla regions, measuring 1.8x3.2x4 cm, with iso to hypointense signals on T1 and hyperintense on T2. Core needle biopsy confirmed DFSP. The patient underwent wide local excision with a pedicled forehead flap. Histopathology confirmed DFSP. The patient received adjuvant radiotherapy (2 Gy daily for five cycles, totaling 60 Gy) and has been disease-free for one year. Facial DFSP is rare and presents unique diagnostic and management challenges. Early diagnosis and comprehensive surgical excision are crucial. Adjuvant therapies and advanced reconstructive techniques significantly improve outcomes. Continued research and documentation of rare DFSP cases are essential to enhance understanding and treatment strategies.