Pediatric Dermatofibrosarcoma Protuberans: Mohs Surgery, Margins, and Management Challenges

Conclusions

• Pediatric DFSP can be difficult to recognize clinically because it often mimics benign lesions, so early biopsy is important.
• The tumor can extend far beyond its visible borders, making complete excision more extensive than expected.
• Achieving negative margins is the central goal, because recurrence is strongly associated with positive or incomplete margins.
• Mohs surgery offers the most reliable margin control for DFSP by examining the entire peripheral and deep margin rather than only a sampled fraction.
• Compared with wide local excision, Mohs appears to have lower recurrence rates in the broader DFSP literature.
• In children, the best operation must balance oncologic control against the practical burdens of anesthesia, logistics, and reconstruction.
• When prolonged anesthesia is a concern, slow Mohs or staged approaches may be a useful alternative in selected cases.
• Pediatric DFSP generally has an excellent prognosis, but recurrence can become catastrophic and much harder to manage after inadequate initial surgery.
• Multidisciplinary coordination is often necessary for pediatric Mohs because children may need plastics, ENT, neurosurgery, or other specialists during resection and reconstruction.
• Because pediatric-specific evidence is limited, management should be individualized based on tumor features, location, and the family’s ability to tolerate the procedure.