Mr Myles Smith was one of the authors of a recently published article on soft tissue sarcoma surgery in the journal Cancer, entitled ‘Outcome after surgical treatment of dermatofibrosarcoma protuberans (DFSP): Is clinical follow‐up always indicated?’
The article examined the outcome of patients treated with surgery for dermatofibrosarcoma protuberans (DFSP). This research was a collaboration between three major international cancer centres: the Royal Marsden Hospital, London; the National Cancer Institute, Amsterdam and the Erasmus Medical Centre-Daniel Den Hoed Cancer Centre Rotterdam.
DFSP is a superficial (skin) soft tissue sarcoma, which is slow growing, but locally aggressive. In large DFSP tumours, those with elements developing into a more aggressive sarcoma (fibrosarcomatous change or transformation), or that have not had adequate surgery to clear the tumour (R1 margin), there is a significant risk of recurrence. However, appropriate surgery is potentially curative, as there is a low risk of metastatic spread. This study was consistent with what we know about DFSP and, moreover, identified that most tumour recurrences were actually identified by patient self-examination (61.7%), as opposed to a small percentage identified by clinical examination by the medical team (3.7%).
Hence, the conclusion of the study was, that it may be able to individualise patient follow up after surgery for DFSP. For example, patients with small (<5cm) tumours, that have been completely excised (R0), with no fibrosarcomatous change, could be offered patient directed follow up as opposed to routine surveillance for up to 10 years.
In an accompanying editorial, ‘Risk-Stratified Surveillance in Dermatofibrosarcoma Protuberans: Less Is More’, doctors Rebecca Gladdy and Jay Wunder of Mount Sinai Hospital, Toronto, welcomed the findings of the paper, whilst emphasising that patients with complex or high-risk DFSPs (FS transformation, large tumours, anatomic location) should be followed up by experts, in keeping with current expert guidelines.