A 10-year Review of Surgical Management of Dermatofibrosarcoma Protuberans

Background: Dermatofibrosarcoma protuberans (DFSP) is a rare skin cancer. Standard treatment in the United Kingdom (UK) is either surgical wide local excision (WLE) or Mohs micrographic surgery (MMS). It is unclear which approach has the lower recurrence rate.Objectives: We undertook a retrospective comparative review of DFSP surgical management in the UK National Health Service (NHS) in order to define:1) current surgical practice for primary and recurrent DFSP2) local recurrence rates for primary DFSP3) survival outcomes for DFSP.Methods: Retrospective clinical case-note review of patients with histologically-confirmed DFSP (January 2004–2014) who have undergone surgical treatment.Results: Surgical management of 483 primary and 64 recurrent DFSP in 11 plastic surgery and 15 dermatology departments was analysed. Almost 75% of primary DFSP (n=362) were treated with WLE and 20.1% (n=97) with MMS. For recurrent DFSP, 68.7% (n=44) and 23.4% (n=15) underwent WLE and MMS, respectively. Recurrent primary DFSP occurred in 6 patients after WLE and none after MMS. Median follow-up was 4.8 years [IQR 3.5, 5.8] with 8 reported deaths during the follow-up analysis period; one confirmed to be DFSP-related.Conclusions: WLE was the commonest surgical modality used to treat DFSP across the UK. The local recurrence rate was very low, occurring only after WLE. Although a prospective RCT may provide more definitive outcomes, in the absence of a clearly superior surgical modality, treatment decisions should be based on patient preference, clinical expertise and cost

Spatial constraints govern competition of mutant clones in human epidermis

Deep sequencing technologies allow for the investigation of clonal evolution in human cancers. Here the authors, combining sequencing data from human skin with mathematical modelling and simulations, suggest that the spatial context of a mutation with respect to other mutant clones may lead to differential clonal evolution