Comparing Mohs micrographic surgery with wide local excision for the surgical treatment of dermatofibrosarcoma protuberans: A Dutch retrospective cohort study

Background: Dermatofibrosarcoma protuberans (DFSP) is a rare malignancy of the skin with an invasive growth pattern that requires effective surgical treatment to prevent recurrences. Objective: To compare recurrence rates after Mohs micrographic surgery (MMS) and wide local excision (WLE) for the treatment of DFSP. Methods: Recurrence rates were determined using data from the nationwide pathology bank (Palga) on DFSPs treated between 2000 and 2022 in three university medical centres. Results: Outcomes were analysed for 393 patients. After WLE, 27 of 209 (13 %) patients developed at least one recurrence over the course of a mean follow-up of 9.8 years (95 % CI 9.1–10.5). For (slow) MMS, there were no recurrences during a mean follow-up time of 6.2 years (95 % CI 5.6–6.8). Most recurrences occurred within five years (85 %). Conclusion: In line with the NCCN Guidelines® and the EDF–EADO–EORTC guideline, this study recommends treating DFSP primarily with (slow) MMS as this treatment leads to a substantially lower recurrence rate than WLE.