Popov Pentscho, Böhling Tom, Asko-Seljavaara Sirpa, Tukiainen Erkki
Helsinki, Finland From the Department of Plastic Surgery, Helsinki University Hospital, and Departments of Pathology, University of Helsinki and Helsinki University Central Hospital Laboratory.
Plast Reconstr Surg. 2007 May;119(6):1779-1784. doi: 10.1097/01.prs.0000246491.79337.25.
Dermatofibrosarcoma protuberans is a rare low-grade sarcoma of the skin with a tendency to recur locally after inadequate excision. Treatment has traditionally been wide excision with a 2- to 3-cm gross margin. Because of the variable results presented in mainly retrospective reports, it has been queried whether local control can be as good with conventional surgery as with micrographic surgery.
Forty patients with dermatofibrosarcoma protuberans treated by surgical excision were operated on at our center from 1987 to 2001. Data were recorded prospectively. Twenty-seven patients presented with a primary tumor and 13 with a locally recurrent tumor primarily operated on elsewhere. Gross and histologic margins were studied in detail.
At a mean follow-up of 40 months, there were no recurrences. Thirty-four patients required single, five patients two, and one patient three operations before the margins were adequate (mean, 1.2 stages per patient). Twenty-three patients (58 percent) needed reconstructions. Tumor-free margins were obtained in 39 patients. The average thickness of surgical gross margins was 3.1 cm; histologically defined margins averaged 1.6 cm.
Good local control can be achieved with wide surgery. Histologic tumor-free margins differ greatly from gross margins and are difficult to assess clinically and macroscopically. Careful postoperative histologic examination with margins measured in millimeters should be carried out to define the adequacy of excision in all directions. On average, a 1.6-cm histologic margin was adequate for complete local control. Most patients can be operated on in one stage. Reconstructions are often needed.
隆突性皮肤纤维肉瘤是一种罕见的低度恶性皮肤肉瘤，切除不充分时易局部复发。传统治疗方法是广泛切除，切缘距肿瘤肉眼边界2至3厘米。由于主要回顾性报告中呈现的结果各异，人们质疑传统手术的局部控制效果是否能与显微手术相媲美。
1987年至2001年在我们中心对40例经手术切除治疗的隆突性皮肤纤维肉瘤患者进行了手术。前瞻性记录数据。27例患者为原发性肿瘤，13例为主要在其他地方接受过手术的局部复发性肿瘤。详细研究了肉眼和组织学切缘。
平均随访时长40个月，无复发情况。34例患者需要进行单次手术，5例患者需要两次手术，1例患者需要三次手术，之后切缘才达到足够标准（平均每位患者1.2个阶段）。23例患者（58%）需要进行重建手术。39例患者获得了无瘤切缘。手术肉眼切缘的平均厚度为3.1厘米；组织学确定的切缘平均为1.6厘米。
广泛手术可实现良好的局部控制。组织学无瘤切缘与肉眼切缘差异很大，临床和宏观上难以评估。应进行仔细的术后组织学检查，测量以毫米为单位的切缘，以确定各个方向切除的充分性。平均而言，1.6厘米的组织学切缘足以实现完全的局部控制。大多数患者可一期手术。通常需要进行重建手术。
