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Soo Park, MD
Soo Park, MD
Posted: Tuesday, September 3, 2024
Despite wide-ranging practice patterns, the results of an international multicenter collaborative, which were published in the journal Cancer, revealed “favorable” oncologic outcomes for patients with the rare skin cancer dermatofibrosarcoma protuberans, which starts in connective tissue cells in the dermis. According to Leah K. Winer, MD, of Fox Chase Cancer Center, Philadelphia, and colleagues, multiple excisions to clear margins remain commonplace and may guide future efforts to optimize margin selection.
The investigators focused on 347 patients who underwent resection at 10 institutions in 8 countries between 2003 and 2021. Despite planned margins of greater than 1 cm in 67.4% of cases, the R0 resection rate was 69.0%. The investigators reported that R0 resection was eventually feasible in 89.5% of patients, but 22.2% overall required reexcision. An R0 resection was achieved at second and third procedures in 80.2% and 86.2% of the latter population, respectively.
Fibrosarcomatous transformation was found in 12.6% of specimens. A total of 6.6% of all patients experienced recurrent disease (n = 23; local: n = 17; distant: n = 6); half of the distant recurrences had fibrosarcomatous transformation. At a median follow-up of 47 months, the disease-specific survival rate was 98.8%. A multivariable analysis demonstrated that R0 margins at index resection were associated with wider circumferential margins and non–fibrosarcomatous transformation histology; however, according to the investigators, a subanalysis revealed the drawbacks of selecting margins larger than 2 cm.
In an institutional press release, Dr. Winer elaborated further: “The rate at which you can clear all the disease in one surgery does not increase much above 2-cm margins. However, at margins greater than 2 cm, you have higher complication rates and lower rates of being able to close the incision just by sewing it shut. Based on the outcomes of this study, we concluded that a 1- to 2-cm margin is an appropriate recommendation.”
Disclosure: Dr. Winer reported no conflicts of interest. For full disclosures of the study authors, visit acsjournals.onlinelibrary.wiley.com.
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