The Consequences of a “Harmless” Frontal Swelling

Figure

a) The affected area after incomplete incisional biopsy in another institution. b) The same site after four further procedures for the resection of dermatofibrosarcoma protuberans of the frontal region, with secondary granulation

A 31-year-old man without antecedent illnesses and in good general condition was referred because of a painless, but growing and cosmetically disturbing swelling on the forehead, which he had first noticed some 9 months previously. It had reached the size of ca. 2 × 1 cm before subtotal excisional biopsy in another institution. The histopathological examination revealed a dermatofibrosarcoma protuberans of the facial skin; multiple further surgical procedures were needed before an R0 resection could be achieved.The resulting cutaneous defect was as large as the palm of a hand. Because of its size, the defect was allowed to heal by secondary intention in combination with a meshed split-thickness skin graft, yielding an adequate cosmetic result. This case underscores the importance of a differential diagnostic work-up even for seemingly harmless cosmetic flaws.

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, Universitätsklinikum Münster, [e-mail]

Conflict of interest statement: The authors state that they have no conflict of interest.

Cite this as: Kupilas FJ, Kleinheinz J: The consequences of a harmless frontal swelling. Dtsch Arztebl Int 2018; 115: 344.
DOI: 10.3238/arztebl.2018.0344

Translated from the original German by Ethan Taub, M.D.