Multidisciplinary Approach to the Management of Extensive Dermato-fibro-sarcomas Involving the Chest Wall
Dermato-fibro-sarcomas are known for high-recurrence rates. The gold standard of management is surgical excision with clear margins. Such margins on the chest results in large defects which require complex reconstructive procedures. We report a case series of patients managed by a multidisciplinary team with good outcomes. A total of 12 patients with extensive dermato-fibro-sarcoma of the anterior chest wall were treated over a period of 5 years in our setting. The age range was 25 to 54 years. Skeletal defects were reconstructed with Prolene mesh and methyl acrylate cement in 10 of the 12 patients. Pedicle flaps were used in nine patients. All margins were clear of tumors, with the nearest margin being 1.5 cm. One patient had a recurrence. No donor-site morbidity was recorded in any of the patients.
In conclusion, a multidisciplinary approach provides improved outcomes in the management of large dermato-fibro-sarcomas of the chest wall. With this approach, extensive dissection of the tumor is achieved, and reconstruction is performed with minimal complication.
20 August 2020 (online)
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- 1 Kreicher KL, Kurlander DE, Gittleman HR, Barnholtz-Sloan JS, Bordeaux JS. Incidence and survival of primary dermatofibrosarcoma protuberans in the United States. Dermatol Surg 2016; 42 (Suppl 1) S24-S31
- 2 Kim BJ, Kim H, Ji US. et al. Wide local excision for dermato-fibro-sarcoma protuberans: a single-center series of 90 patients. J Cancer 2017; 8 (07) 1319-1323
- 3 Lowe GC, Onajin O, Baum CL. et al. A comparison of Mohs micrographic surgery and wide local excision for treatment of dermatofibrosarcoma protuberans with long-term follow-up: The Mayo Clinic experience. Dermatol Surg 2017; 43 (01) 98-106
- 4 Fields RC, Hameed M, Qin LX. et al. Dermatofibrosarcoma protuberans (DFSP): predictors of recurrence and the use of systemic therapy. Ann Surg Oncol 2011; 18 (02) 328-336
- 5 DuBay D, Cimmino V, Lowe L, Johnson TM, Sondak VK. Low recurrence rate after surgery for dermatofibrosarcoma protuberans: a multidisciplinary approach from a single institution. Cancer 2004; 100 (05) 1008-1016
- 6 Sanna S, Brandolini J, Pardolesi A. et al. Materials and techniques in chest wall reconstruction: a review. J Vis Surg 2017; 3: 95
- 7 Foroulis CN, Kleontas AD, Tagarakis G. et al. Massive chest wall resection and reconstruction for malignant disease. OncoTargets Ther 2016; 9: 2349-2358
- 8 Chen Y-T, Tu W-T, Lee W-R, Huang YC. The efficacy of adjuvant radiotherapy in dermatofibrosarcoma protuberans: a systemic review and meta-analysis. J Eur Acad Dermatol Venereol 2016; 30 (07) 1107-1114