SECTION EDITOR: MICHAEL BIGBY, MD; ASSISTANT SECTION EDITORS: OLIVIER CHOSIDOW, MD, PhD; ROBERT P. DELLAVALLE, MD, PhD, MSPH; DAIHUNG DO, MD; URBÀ GONZÁLEZ, MD, PhD; CATALIN M. POPESCU, MD, PhD; HYWEL WILLIAMS, MSc, PhD, FRCP
Author Affiliations: Department of Dermatology and Research Unit EA 4339 “Skin, Environment, and Cancer,” Ambroise Paré University Hospital (Drs Sei and Saiag), and Assistance Publique–Hôpitaux de Paris (Dr Beauchet), Boulogne-Billancourt, Assistance Publique–Hôpitaux de Paris (Drs Sei and Saiag) and Department of Public Health, Ambroise Paré University Hospital (Dr Beauchet), University of Versailles, Saint Quentin en Yvelines, and Dermatology Department, Lyon–Sud University Hospital, Pierre Benite (Dr Amini), France. Dr Foroozan is in private practice in Lyon, France.
Objective To summarize evidence about the recurrence of dermatofibrosarcoma protuberans (DFSP) following Mohs micrographic surgery (MMS).
Data Sources MEDLINE, Cochrane Library, EMBASE, Pascal, Biosis, CisMef, BDSP, Scopus, and Web of Knowledge databases were searched for the period January 1, 1995, to August 31, 2011. Search terms were Mohs micrographic surgery, dermatofibrosarcoma protuberans, and their synonyms. No language restriction was used.
Study Selection Two of us selected randomized controlled trials or nonrandomized trials comparing the recurrence of DFSP among patients undergoing MMS vs wide local excision. The search retrieved 384 references, of which 31 were reviewed in detail.
Data Extraction Twenty-three nonrandomized trials (4 comparative and 19 noncomparative) were included, from which data were extracted by 2 of us independently. The methodological quality was assessed using the Cochrane Handbook for Systematic Reviews of Interventions.
Data Synthesis Moderate-quality evidence (level B) was found for recurrence of DFSP after MMS (1.11%; 95% CI, 0.02%-6.03%) vs after wide local excision (6.32%, 95% CI, 3.19%-11.02%). A mean raw recurrence rate of 1.03% (95% CI, 0.37%-2.22%) was found after MMS among 19 nonrandomized noncomparative trials (low-quality evidence [level C]). The mean follow-up periods ranged from 26 to 127 months. The mean time to recurrence was 68 months.
Conclusions A weak recommendation is given in favor of MMS or similar surgical techniques with meticulous histologic evaluation of all margins as the first-line therapy for DFSP, particularly in recurrence-prone regions. Attention should be given to longer than a 5-year follow-up period. High-quality trials with sufficient follow-up periods should be encouraged.
Foroozan M, Sei J, Amini M, Beauchet A, Saiag P. Efficacy of Mohs Micrographic Surgery for the Treatment of Dermatofibrosarcoma ProtuberansSystematic Review. Arch Dermatol. 2012;148(9):1055-1063. doi:10.1001/archdermatol.2012.1440