The authors presented the case of a dermatofibrosarcoma protuberans (DFSP) on the forehead of a 31 year old man (1). Multiple further surgical procedures were required before an R0 resection was achieved. Since a longer follow-up of the patient is not presented it remains elusive whether an age-appropriate esthetically acceptable reconstruction will ever be successful.
More than 90% of DFSP cases are associated with a chromosomal translocation (t [17; 22]) which can be treated by using a tyrosine kinase inhibitor—for example, imatinib (2–4). Interested readers were not informed about molecular findings in this patient but under (neoadjuvant) treatment with imatinib, the surgical interventions would probably have been less extensive.
Imatinib is approved for the treatment of adult patients with non-resectable DFSP. In the DFSP guideline, the option of imatinib-based preoperative tumor size reduction is mentioned, but as off-label use in the neoadjuvant setting.
In our view, the question of when a tumor should be regarded as “non-resectable” should be discussed in an interdisciplinary tumor board while considering the patient’s age and the tumor’s location.
PD Dr. med. Maria Gaiser
Prof. Dr. med. Jochen Utikal
Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, Mannheim sowie Klinische Kooperationseinheit Dermatoonkologie am Deutschen Krebsforschungsinstitut (DKFZ), Heidelberg
|1.||Kupilas FJ, Kleinheinz J: The consequences of a “harmless“ frontal swelling. Dtsch Arztebl Int 2018; 115: 344 VOLLTEXT|
|2.||McArthur GA, Demetri GD, van Oosterom A, et al.: Molecular and clinical analysis of locally advanced dermatofibrosarcoma protuberans treated with imatinib: Imatinib Target Exploration Consortium Study B2225. J Clin Oncol 2005; 23: 866–73 CrossRef MEDLINE|
|3.||Rutkowski P, van Glabbeke M, Rankin CJ, et al.: Imatinib mesylate in advanced dermatofibrosarcoma protuberans: pooled analysis of two phase II clinical trials. J Clin Oncol 2010; 28: 1772–9 CrossRef MEDLINE PubMed Central|
|4.||Urgurel 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|