Efficacy of Mohs Micrographic Surgery for the Treatment of Dermatofibrosarcoma Protuberans Systematic Review
Archives of dermatology (Impact Factor: 4.79). 09/2012; 148(9):1055-63. DOI: 10.1001/archdermatol.2012.1440
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.
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ABSTRACT: Dermatofibrosarcoma is a rare low-grade sarcoma characterized in more than 90% of cases by (17q22; 22q13) translocation leading to a fusion transcript COL1A1-PDGFB. Surgical therapy is the standard of care; however, tyrosine-kinase inhibitors targeting PDGFR are of interest in unresectable or rare metastatic tumors. Imatinib mesylate has been approved in this indication and research is going on with other inhibitors.
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ABSTRACT: We are grateful to Barlow et al. for their interest in our critically appraised topic on surgical treatment of dermatofibrosarcoma protuberans (DFSP). The authors state that 'Reviews of this nature seldom surprise the reader in either their assessments of the data or in their conclusions that randomised controlled trials are required'. In our critically appraisal of this topic, we would like to reiterate that although there were numerous limitations to the evidence available, we reported that MMS recurrence rates were always less than WLE.
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