Br J Dermatol. 2021 Apr;184(4):e126-e147. doi: 10.1111/bjd.19837.
Dermatofibrosarcoma protuberans (DFSP) is a rare, slow-growing skin cancer that is primarily treated with surgery. Because this cancer can spread deep into the skin and surrounding tissue in an irregular way, it is notoriously difficult to ensure that it has been completely removed after conventional surgery and histological examination. Standard treatment in the UK is either wide local excision (WLE) or Mohs micrographic surgery (MMS). In WLE, the tumour and a predetermined margin of skin around it is removed. The margin is usually in the range of 1-5 cm. MMS involves removing the tumour and a much smaller margin around it, followed by immediate microscopic examination of the edges of the removed skin. Areas still containing tumour cells are then removed. This is repeated until all the edges are clear of tumour cells. This method allows the surgeon to track the tumour and only remove tissue where is it present. This study was carried out at several centres in the UK. Clinical records were examined of cases of DFSP between 1 January 2004 and 31 December 2013. This study includes the largest number of cases of DFSP reported in the UK: 483 new and 64 recurring cases of DFSP, in 11 plastic surgery and 15 dermatology departments. The methods used to perform these 547 surgeries were analysed. Almost 75% of cases of new DFSP were treated with WLE and 20% were treated with MMS. For recurring DFSP, 69% of patients had WLE and 23% had MMS. After a median follow-up period of just over 2 years for new DFSP and 1.6 years for recurring DFSP, the tumour returned in six patients after WLE and none after MMS. Although no DFSP were found to have returned after MMS, the study could not detect any significant difference in recurrences between the two surgical methods. Until data from more detailed studies are available, the choice of treatment for DFSP should be based on the patient's preference, treatment availability and cost. Linked Article: Durack et al. Br J Dermatol 2021; 184:731-739.
隆突性皮肤纤维肉瘤（DFSP）是一种罕见的、生长缓慢的皮肤癌，主要通过手术治疗。由于这种癌症会以不规则的方式向皮肤和周围组织深处扩散，因此在常规手术后通过组织学检查确保完全切除是非常困难的。英国的标准治疗方法是广泛局部切除（WLE）或 Mohs 显微外科手术（MMS）。在 WLE 中，肿瘤及其周围预定的皮肤边界会被切除。边界通常在 1-5 厘米之间。MMS 涉及切除肿瘤及其周围更小的边界，然后立即对切除皮肤的边缘进行显微镜检查。然后切除仍含有肿瘤细胞的区域。重复此过程，直到所有边缘都没有肿瘤细胞为止。这种方法允许外科医生跟踪肿瘤并仅切除存在肿瘤的组织。这项研究在英国的几个中心进行。对 2004 年 1 月 1 日至 2013 年 12 月 31 日期间诊断的 DFSP 病例的临床记录进行了检查。这项研究包括英国报告的最大数量的 DFSP 病例：11 个整形外科和 15 个皮肤科科室共报告了 483 例新发病例和 64 例复发病例。分析了进行这 547 例手术的方法。近 75%的新发病例采用 WLE 治疗，20%采用 MMS 治疗。对于复发性 DFSP，69%的患者采用 WLE，23%的患者采用 MMS。新发病例的中位随访期略超过 2 年，复发病例的随访期为 1.6 年。在 WLE 治疗后，有 6 名患者的肿瘤复发，而在 MMS 治疗后无患者肿瘤复发。尽管在 MMS 治疗后没有发现 DFSP 复发，但这项研究无法检测到两种手术方法之间的复发率存在任何显著差异。在更详细的研究数据可用之前，DFSP 的治疗选择应基于患者的偏好、治疗的可及性和成本。相关文章：Durack 等人，《英国皮肤病学杂志》2021；184：731-739。
