State of the art therapy of dermatofibrosarcoma protuberans (DFSP) consists of surgical resection with micrographic margin control (1). When using the multikinase inhibitor imatinib, the response rate after up to three months is 36–57%. Meanwhile the morphology of the tumor cells changes so that safe and certain histopathological distinction from vital tumor cells to the adjacent tissue becomes more difficult. Imatinib is not licensed for neoadjuvant therapy of DFSP. Off-label use can, however, be discussed for tumors regarded as difficult or inoperable, for the purpose of tumor debulking (2).
The decision about the resectability of the DFSP was discussed prior to the skin tumor conference and—in analogy to the DFSP guideline—was made in favor of state of the art treatment in view of its size, localization, operability, and the patient’s age. In addition to the interdisciplinary team, a plastic facial surgeon should be consulted, especially for surgery in the exposed facial area.
Secondary wound healing in combination with a meshed split-thickness skin graft is one of the tried and tested therapeutic approaches and yields good esthetic results in plastic facial surgery if the possibilities of local flap surgery are exhausted (3). In the described case (4), an adequate cosmetic result was achieved, with little functional impairment.
Dr. med. univ. Dr. med. dent. Florian J. Kupilas, M.Sc., D.A.L.M.
Prof. Dr. med. Dr. med. dent. Johannes Kleinheinz
Klinik für Mund-, Kiefer- und Gesichtschirurgie
Conflict of interest statement
The authors of both contributions declare that no conflict of interest exists.
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|2.||Ugurel S, Mentzel T, Utikal J, et al.: Neoadjuvant imatinib in advanced primary or locally recurrent dermatofibrosarcoma protuberans: a multicenter phase II DeCOG trial with long-term follow-up. Clin Cancer Res 2014; 20: 499–510 CrossRef MEDLINE|
|3.||Rustemeyer J, Guenther L, Bremerich A: Complications after nasal skin repair with local flaps and full-thickness skin grafts and implications of patients‘ contentment. Oral Maxillofacial Surg 2009; 13: 15–9 CrossRef MEDLINE|
|4.||Kupilas FJ, Kleinheinz J: The consequences of a “harmless“ frontal swelling. Dtsch Arztebl Int 2018; 115: 344 VOLLTEXT|