DFSP Treated with “Slow Mohs”: Laborious but Accurate

Traditionally, wide local excision with margins of 3 cm or more has been the standard treatment for dermatofibrosarcoma protuberans (DFSP). These investigators report the use of Mohs surgery with permanent sections in 35 patients. Mohs sections were taken as usual, but formalin fixed and prepared as paraffin-embedded sections rather than frozen sections. A Mohs surgeon and a dermatopathologist reviewed the slides. If positivity was detected at the margin, the patient returned the next day for another stage, with Mohs continued daily until clear margins were obtained. None of the patients had metastatic disease, and none had received nonsurgical treatment.

Of these tumors, 48.6% were cleared in one stage; the median defect size was 46.8 cm². …