Deepak Narayan

A New Algorithm for the Management of Dermatofibrosarcoma Protuberans: a Thesis Submitted to the Yale University School of Medicine in Partial ... for the Degree of Doctor of Medicine Deepak Narayan

The purpose of this project was to design an algorithm for the management of Dermatofibrosarcom Protuberans (DFSP.) The National Cancer Center Network guidelines suggest immediate reconstruction in most cases after DFSP resection. We believe this algorithm is inadequate. Due to the infiltrating nature of DFSP, tumor margins are often positive after resection. Immediate reconstruction in the context of residual tumor is problematic because of the risk for spreading microscopic disease and the potential to compromise reconstructive options. Here we examined the prevalence of positive margins on permanent pathology after immediate closure following surgical resection of DFSP. Forty percent of patients who underwent immediate closure were found to have positive margins on permanent pathology. Given these findings, we propose a treatment algorithm focused on more conservative surgical management of DFSP in which negative margins are established before closure. Mohs surgery, which allows for immediate identification of pathology, plays a central role.