Foroozan Majid, Sei Jean-François, Amini Mona, Beauchet Alain, Saiag Philippe
Department of Dermatology and Research Unit EA 4339 “Skin, Environment, and Cancer,” Ambroise Paré University Hospital, France.
Arch Dermatol. 2012 Sep;148(9):1055-63. doi: 10.1001/archdermatol.2012.1440.
OBJECTIVE To summarize evidence about the recurrence of dermatofibrosarcoma protuberans (DFSP) following Mohs micrographic surgery (MMS). DATA SOURCES MEDLINE, Cochrane Library, EMBASE, Pascal, Biosis, CisMef, BDSP, Scopus, and Web of Knowledge databases were searched for the period January 1, 1995, to August 31, 2011. Search terms were Mohs micrographic surgery, dermatofibrosarcoma protuberans, and their synonyms. No language restriction was used. STUDY SELECTION Two of us selected randomized controlled trials or nonrandomized trials comparing the recurrence of DFSP among patients undergoing MMS vs wide local excision. The search retrieved 384 references, of which 31 were reviewed in detail. DATA EXTRACTION Twenty-three nonrandomized trials (4 comparative and 19 noncomparative) were included, from which data were extracted by 2 of us independently. The methodological quality was assessed using the Cochrane Handbook for Systematic Reviews of Interventions. DATA SYNTHESIS Moderate-quality evidence (level B) was found for recurrence of DFSP after MMS (1.11%; 95% CI, 0.02%-6.03%) vs after wide local excision (6.32%, 95% CI, 3.19%-11.02%). A mean raw recurrence rate of 1.03% (95% CI, 0.37%-2.22%) was found after MMS among 19 nonrandomized noncomparative trials (low-quality evidence [level C]). The mean follow-up periods ranged from 26 to 127 months. The mean time to recurrence was 68 months. CONCLUSIONS A weak recommendation is given in favor of MMS or similar surgical techniques with meticulous histologic evaluation of all margins as the first-line therapy for DFSP, particularly in recurrence-prone regions. Attention should be given to longer than a 5-year follow-up period. High-quality trials with sufficient follow-up periods should be encouraged.
总结关于隆突性皮肤纤维肉瘤（DFSP）在莫氏显微外科手术（MMS）后复发的证据。数据来源：检索了1995年1月1日至2011年8月31日期间的MEDLINE、Cochrane图书馆、EMBASE、Pascal、Biosis、CisMef、BDSP、Scopus和Web of Knowledge数据库。检索词为莫氏显微外科手术、隆突性皮肤纤维肉瘤及其同义词。未设语言限制。研究选择：我们两人选择了比较接受MMS与广泛局部切除的患者中DFSP复发情况的随机对照试验或非随机试验。检索获得384篇参考文献，其中31篇进行了详细审查。数据提取：纳入23项非随机试验（4项比较性试验和19项非比较性试验），由我们两人独立从中提取数据。使用《Cochrane系统评价干预措施手册》评估方法学质量。数据综合：发现MMS后DFSP复发的证据质量中等（B级）（1.11%；95%CI，0.02%-6.03%），而广泛局部切除后为（6.32%，95%CI，3.19%-11.02%）。在19项非随机非比较性试验中（低质量证据[C级]），MMS后平均原始复发率为1.03%（95%CI，0.
