Title : A case report of dermatofibrosarcoma protuberans of the scalp mimicking trichilemmal cyst
Abstract:
Introduction:
We present a case of a 47-year-old female who had a painless soft mass on her scalp misdiagnosed as a trichilemmal cyst instead of dermatofibroma protuberans.
Case Presentation:
In January 2021, a woman presented to a clinic with a headache and swelling on the right side of her scalp, which was diagnosed as trichilemmal cysts. Two years later, she returned with a large, rapidly increasing swelling in the same area and was diagnosed with Dermatofibrosarcoma Protuberans (DFSP), a rare type of skin cancer. The cancer had not spread to other organs, and an urgent referral was made to oncology for further treatment. The patient underwent wide excision of the lesion and was discharged from the hospital after an uneventful postoperative period.
Discussion:
Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue neoplasm that can affect any part of the body, with
symptoms including a painless bump or growth resembling a pimple. Its cause is unknown, but potential risk factors include skin injury, tattoos, and pre-existing scars. DFSP is usually diagnosed by pathology and can be treated by total excision, during which the surgeon removes the tumor and some healthy tissue from the area. Metastasis is uncommon, but a metastatic workup should be performed. DFSP has an incidence rate of 0.8 to 4.5 cases per million persons per year and accounts for approximately 6% of soft tissue sarcomas.
Conclusion:
DFSP is a rare, slow-growing tumor that often occurs on the trunk or proximal extremities but can also occur on the
scalp. Misdiagnosis may occur, leading to delayed complete excision. Surgeons should be aware of this to improve
outcomes, and follow-up is important due to the high rate of local recurrence.
Audience Take Away
- Dermatofibrosarcoma protuberans (DFSP) is a rare and aggressive soft tissue that affects the skin
- DFSP has a strong tendency for local recurrence after resection
- The definitive diagnosis of DFSP requires tissue histology after excisional biopsy, and surgical resection is the mainstay of DFSP treatment
- The preferred initial treatment for localized DFSP is resection with pathologically negative margins
- The case study presented in the paragraphs illustrates a misdiagnosis of DFSP as a trichilemmal cyst, emphasizing the importance of correct diagnosis and prompt referral to the appropriate specialists
