EFFECT OF RESECTION MARGINS ON DERMATOFIBROSARCOMA PROTUBERANS OF THEHEAD AND NECK

Objective: To determine clinical and surgical factors that affect the recurrence of dermatofibrosarcoma protuberans of the head and neck. De sign: Retrospective case series of 32 patients who were seen between 1 960 and 1995 with a diagnosis of dermatofibrosarcoma protuberans of th e head and neck. Data extracted from patient records included sex, age at diagnosis, tumor site, presence or absence of tumor-free margins, initial and salvage treatment, time to recurrence, and status after la st treatment. Setting: Academic tertiary: care referral center. Interv ention: Surgical excision and radiation therapy. Results: Univariate K aplan-Meier analysis for recurrence showed the difference in survival to be statistically significant (P < .05) between patients who had wid e (greater than or equal to 2 cm) surgical margins vs those who had cl ose (< 2 cm) margins. Univariate Kaplan-Meier analysis for recurrence with or without radiation as the grouping variable showed the differen ce to be statistically significant (P < .01). Similar analyses with se x, age, tumor site, and size of tumor as the grouping variables were n ot statistically significant. Multivariate Cox regression analysis was used with sex, age, and close or wide margins as variables. Close mar gins (< 2 cm) had a statistically significant positive correlation wit h recurrence (P < .05), while sex and age were not associated with rec urrence. Conclusion: Surgical margins of at least 2 cm should be used in all cases of dermatofibrosarcoma protuberans of the head and neck t o prevent recurrence.