A Challenging Case of Dermatofibrosarcoma Protuberans (DFSP) Presenting With a Cone-Shaped Scalp Mass

Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous malignancy characterized by extensive subclinical extension. Because of its locally destructive nature, most dermatologic surgeons perform Mohs micrographic surgery (MMS) to ensure negative margins. Undergoing multiple stages of MMS can be burdensome, and the subsequent reconstruction of massive cutaneous defects remains highly challenging. Here, we report a case of a 44-year-old man with a recurrent DFSP of the scalp who developed a large surgical defect following slow MMS and was successfully managed with secondary intention healing (SIH). He presented with an adult fist-sized, flesh-colored mass on the occipital scalp, clinically recurring from DFSP locally excised 3 years earlier. Brain MRI revealed a 5.5 cm-sized enhancing mass without bone invasion. We performed four stages of slow MMS under local anesthesia, with partially excised basal periosteum. The final postoperative defect measured approximately 12 cm x 10 cm. Complete epithelialization was achieved within 19 weeks without postoperative complications, including infection. SIH may offer a practical and effective reconstructive strategy for managing extensive post-excisional defects in non-melanoma skin cancers, including DFSP.