AccScience Publishing / CP / Online First / DOI: 10.36922/CP025070011
CASE REPORT

A clinical case report on dermatofibrosarcoma protuberans

Isabella Gianina Raffa1 Christoper Mendez2 Jose E. Mendez3 Sultan S. Ahmed4,5* Syed A. A. Rizvi5* Rafiq J. Baksh6
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1 Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, United States of America
2 Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois, United States of America
3 Dermatology Consultants P.A., Hialeah, Florida, United States of America
4 JAS Medical Management, Miramar, Florida, United States of America
5 College of Biomedical Sciences, Larkin University, Miami, Florida, United States of America
6 Maimonides Midwood Community Hospital, Brooklyn, New York, United States of America
Received: 10 February 2025 | Revised: 22 March 2025 | Accepted: 7 April 2025 | Published online: 24 April 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract

This case report highlights the diagnostic challenges and therapeutic considerations when dermatofibrosarcoma protuberans (DFSP) present in atypical locations, such as the head and neck. A 46-year-old Hispanic male presented with a large, rapidly growing, protruding mass on the left medial forehead, initially diagnosed through ultrasound as a benign cyst. The lesion exhibited a significant increase in size over 5 months. Physical examination revealed a firm nodular mass without signs of inflammation or lymphadenopathy. The lesion was excised for biopsy, and histopathological analysis confirmed a diagnosis of DFSP, characterized by spindle cells arranged in a storiform pattern. Immunohistochemical staining revealed strong CD34 positivity, with negative markers for desmin, factor XIIIa, and SOX10. The tumor exhibited an infiltrative pattern, extending into the skeletal muscle. The patient was referred for wide local excision due to the complexity of achieving clear margins in a cosmetically sensitive area such as the forehead. DFSP most commonly occurs on the trunk and proximal extremities, with less frequent involvement of the head and neck. This case is notable for its atypical location on the forehead, making surgical excision particularly challenging due to the need for margin control while preserving facial esthetics. Initial misdiagnosis as a benign cyst highlights the diagnostic difficulty of DFSP in uncommon locations. The tumor’s rapid growth and deep infiltration into skeletal muscle are further complicated management, requiring careful surgical planning to prevent a recurrence. Long-term follow-up is essential due to the high recurrence rate of DFSP when margins are inadequate.

Keywords
Dermatofibrosarcoma protuberans
CD34
Spindle cell
Cutaneous sarcoma
Local recurrence
Head and neck tumor
Wide local excision
Skeletal muscle invasion
Funding
None.
Conflict of interest
The authors declare they have no competing interests.
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