Dermatofibrosarcoma protuberans of the head and face: A retrospective single-center study highlighting its predilection for the cheek region

Dermatofibrosarcoma protuberans (DFSP) is an uncommon cutaneous sarcoma that infrequently involves the head and face. Despite its low incidence, the complex anatomical subunits of this region and frequent misdiagnosis can result in functional impairment and challenging reconstruction. However, the distribution characteristics of DFSP in the head and face have not yet been systematically evaluated. This study aimed to characterize the distribution of DFSP in the head and face to provide guidance for clinical diagnosis. We retrospectively reviewed patients who underwent treatment for DFSP involving the head and face at our hospital. The associations between tumor location and patient characteristics—including sex, age, tumor size, history of trauma, and histopathological features—were systematically analyzed. Among the 161 cases, 26 (16.1%) involved DFSP of the head and face. The highest tumor frequency was observed in the cheek region (65.38%). Patients with DFSP located in the cheek were older than those with DFSP in non-cheek regions (48.82 vs. 37.22 years, P =0.04). Histologically, among the 26 cases, 23 were classic DFSP and 3 were fibrosarcomatous dermatofibrosarcoma protuberans (FS-DFSP), a more aggressive histologic subtype. The proportion of FS-DFSP was lower in the cheek region than in non-cheek areas (0 vs. 3, P =0.032). DFSP of the head and face demonstrated a predilection for the cheek region. Recognition of this distribution pattern may assist dermatologists in the clinical assessment and management of patients, particularly for lesions involving the cheeks.