PMC7533289_01
Planned en bloc excision of lesion with 2 cm margins (A). Full thickness defect exposing the oral cavity, mandible (B). Inset of radial forearm free flap (C). Re-excision of 2 cm tissue around reconstructed flap (D). 1 year follow up (E).
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Intraorally, a 3 cm irregularly shaped, bulky submucosal mass was present in the left buccal mucosa extending anteriorly to the vestibule of the mouth (Fig. 1A). The lesion was resected with 2 cm margins in all directions, creating a full thickness defect of the left cheek (Fig. 1B). This defect was reconstructed with a folded radial forearm free flap (Fig. 1C). Subsequent re-excision was performed with 2 cm additional peripheral and 1.5 cm deep margins (Fig. 1D). One year postoperatively, there was no evidence of recurrent disease (Fig. 1E).
Pathologic analysis of initial specimen demonstrating dermatofibrosarcoma protuberans originating within the subcutaneous tissue. Mucosa and submucosa are seen above (Hematoxylin-eosin stain, x4) (A). Same specimen demonstrating interwoven fascicles with variable collagen reproduced at x10 magnification (B). Pathologic analysis of re-excision demonstrating dermatofibrosarcoma protuberans within the subcutaneous tissues (Hematoxylin-eosin stain, x10) (C).
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The final pathology report noted positive margins in both peripheral and central deep subcutaneous tissues (Fig. 2A, B).