Surgical Mx of dermatofibrosarcoma protuberans
Published in the Journal of Current Surgery, the authors present a unique case of a 29-year-old female who presented with a dry, shallow ulcerated right posterior shoulder mass diagnosed as DFSP, and describe their surgical management.

A 29-year-old female with no significant past medical history presented with a right posterior shoulder mass that recently became painful and ulcerated. The patient was unsure of how long the mass had been present but had become more aware of it over the past 2 - 3 months. She also reported recent skin changes over the mass, concerning for infection, but denied any erythema or discharge.

The mass was indurated, mobile, tender, and approximately 2 × 2 cm in size. The mass also had a necrotic surface with a dry, shallow central ulcer measuring 1 × 0.7 cm. Preoperative diagnosis was suspicious for an infected sebaceous cyst. A formal excision of the mass measuring 2.5 × 1.5 × 1.2 cm was performed, and pathology was significant for DFSP with positive margins. Hematology-oncology was consulted and recommended wide local re-excision with clear margins. No imaging was recommended.

Seventy-six days after her first procedure, the patient underwent wide local re-excision of the right posterior shoulder mass. To allow for adequate surgical margins, a mass with 1 cm borders extending from the previous incision site was excised and sent for intraoperative frozen section evaluation. The mass measured 5.1 × 3.2 × 1.9 cm.

Pathology showed lateral margins that were negative for neoplastic cells but the deep segment demonstrated focal spindle cell proliferation uncertain for DFSP or reactive fibroblastic scar. The intraoperative diagnosis was indeterminate at that time, and the decision to continue with wound closure was made. Immunohistochemical staining completed 4 days after the procedure confirmed focal spindle cell proliferation favoring reactive fibroblastic scar.

Because the margins were negative, postoperative radiotherapy was not recommended, and the patient will be followed up on an as needed basis.

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