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

Cherees E. Klint; Martijn G.H. Sanders; Lukas B. Been; Dirk J. Grünhagen; K. Mosterd; Loes M. Hollestein; Renate R. van den Bos

doi:10.1016/j.ejcskn.2025.100287

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

Cherees E. Klint
, Martijn G.H. Sanders
, Lukas B. Been
, Dirk J. Grünhagen
, K. Mosterd
, Loes M. Hollestein
, Renate R. van den Bos^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

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.

Original language	English
Article number	100287
Number of pages	6
Journal	EJC Skin Cancer
Volume	3
DOIs	https://doi.org/10.1016/j.ejcskn.2025.100287
Publication status	Published - 14-Mar-2025

Keywords

Breuninger excision
Dermatofibrosarcoma protuberans
Histological clearance
Mohs micrographic surgery
Recurrence
Surgical excision

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@article{c052ed98401043a3bdedc3c80d977a86,

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

abstract = "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{\textregistered} 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.",

keywords = "Breuninger excision, Dermatofibrosarcoma protuberans, Histological clearance, Mohs micrographic surgery, Recurrence, Surgical excision",

author = "Klint, \{Cherees E.\} and Sanders, \{Martijn G.H.\} and Been, \{Lukas B.\} and Gr{\"u}nhagen, \{Dirk J.\} and K. Mosterd and Hollestein, \{Loes M.\} and \{van den Bos\}, \{Renate R.\}",

note = "Publisher Copyright: {\textcopyright} 2025 The Authors",

year = "2025",

month = mar,

day = "14",

doi = "10.1016/j.ejcskn.2025.100287",

language = "English",

volume = "3",

journal = "EJC Skin Cancer",

issn = "2772-6118",

publisher = "Elsevier",

}

TY - JOUR

T1 - Comparing Mohs micrographic surgery with wide local excision for the surgical treatment of dermatofibrosarcoma protuberans

T2 - A Dutch retrospective cohort study

AU - Klint, Cherees E.

AU - Sanders, Martijn G.H.

AU - Been, Lukas B.

AU - Grünhagen, Dirk J.

AU - Mosterd, K.

AU - Hollestein, Loes M.

AU - van den Bos, Renate R.

PY - 2025/3/14

Y1 - 2025/3/14

N2 - 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.

AB - 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.

KW - Breuninger excision

KW - Dermatofibrosarcoma protuberans

KW - Histological clearance

KW - Mohs micrographic surgery

KW - Recurrence

KW - Surgical excision

UR - https://www.scopus.com/pages/publications/105013767518

U2 - 10.1016/j.ejcskn.2025.100287

DO - 10.1016/j.ejcskn.2025.100287

M3 - Article

AN - SCOPUS:105013767518

SN - 2772-6118

VL - 3

JO - EJC Skin Cancer

JF - EJC Skin Cancer

M1 - 100287

ER -

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

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