Dermoscopy of Dermatofibrosarcoma Protuberans: A Systematic Review and Case Series of Three Patients

Dermatofibrosarcoma protuberans is a rare, locally aggressive cutaneous sarcoma characterised by slow progression and often nonspecific clinical features. Early-stage lesions may resemble benign or pigmented dermatoses, leading to diagnostic delays. We conducted a systematic review of 17 publications reporting dermoscopic findings of DFSP and added three additional histologically confirmed cases from our center, totaling 45 cases. The most common findings included vascular structures (80%), pigmented networks (73%), and a pink background (64%). Nodular lesions displayed a greater variety of dermoscopic patterns, while plaque-type lesions were more frequently associated with pigmented networks. Notably, in Bednar tumours, bluish pigmentation and blue-white veil-like structures were observed more commonly, possibly reflecting melanin-laden dendritic cells and increased collagen content. Atrophic variants occasionally presented with yellowish, structureless areas, potentially due to the enhanced visibility of subcutaneous fat. Although no pathognomonic features were identified, certain dermoscopic patterns were more prevalent in specific subtypes of dermatofibrosarcoma protuberans. The presence of multiple dermoscopic features, particularly in early or non-protuberant lesions, may increase clinical suspicion. Dermoscopy remains a valuable non-invasive tool that aids in the early recognition of skin conditions and informs biopsy decisions.