A Rare Case of Misdiagnosis: Recurrence of Dermatofibrosarcoma Protuberans That Was Treated Surgicallyas a Keloid.

AIM: In this report, we presented the patient with Dermatofibrosarcoma Protuberans (DFSP), removed by considering as the keloid scar in the general surgery clinic with misdiagnosis. CASE REPORT: The patient was a 19-year-old female student with no scar or previous trauma history in the lesion area. Pathology report of excisional biopsy revealed as a DFSP, reachedsubcutis and dermis. In staging by CT, there had been no distant metastases. There was a lesion with the size of 2x1.5x1.5cm. A large resection was made to include the entire mass and the lower fascia. The defect area was repaired with a Limberg flap. There was no tumor recurrence in the first 6 months following the operation with high-level aesthetics for patient satisfaction.
CONCLUSION: DFSP should be remembered in cases of operative or spontaneous keloid scarring lesions. The surgical treatment is possible after extensive resection with flap or graft repair.

INTRODUCTION

A tumor called Dermatofibrosarcoma Protuberans (DFSP) is a malign mesenchymal mass, which commonly roots from thedermis (1). It develops in the form of painless, slowly growing plaques and nodules. The incidence of DFSP is about 5 million/year all over the world. Because, DFSP tends to rise slowly, tumour seldom spreads to other parts of the body in silence (2). Its risk factors remain unclear; however, surgical local excision provides an exact healing (3).

Keloids are particularly bulging after a trauma in susceptible tissues, or in the color of the skin felt hard with anexamination or pinky red colored benign swelling (4). The method to be applied in the treatment is injection of suitable creams, injection into keloids, cryotherapy, radiotherapy and surgical treatment methods. As well-known, areas around the chest are common locations for keloids (5, 6). They do not usually require treatment, as they do not pose a threat to life and do not cause any serious pain or other problems outside the image. However, there are different treatment options available for keloids that make the image worse to make the person feel unhappy. This case was one of them, who applied to the dermatologist with feeling unhappy due to the lesion around her chest. However, the missed point by the dermatologist and general surgeon was the type of this lesion that misdiagnosed and treated surgically as keloid, instead of a DFSP.

In this report, we presented the patient with a DFSP, removed by considering as the keloid scar in the general surgery clinic with misdiagnosis.

CASE REPORT

The patient was a 19-year-old female student with no scar or previous trauma history around the lesion area. According to the patient’s verbal expression, this lesion started as a small red-pimple initially a year ago in the chest. It slowly began to grow and become conspicuous. After being evaluated by a dermatologist, the patient redirected to the general surgery department. Hence, the patient then had applied to the general surgery clinic. The general surgery had diagnosed this lesion as a keloid tissue, as described in the first examination report. Here, a fish eye incision had been performed by general surgeon and the excision had been closed primer after the surgical excision procedure. The excised tissue sample had been taken to thepathology department for examination. Although the pathology result report had been expecting as keloid, the report of pathology had revealed this sample asa DFSP, reached subcutis and dermis. In staging by CT, there had been no distant metastases. After all this living process, she was referred to a plastic surgery unit for assessment with a recurrence. In our first examination, there was a lesion with 2x1.5x 1.5 cm in size. After giving detailed information about the surgical application, we applied surgical treatment to the patient under local anesthesia (Figure 1). A large resection was made to include the entire mass and the lower fascia. Afterwards, the defect area was repaired with a Limberg flap. Flap application was successful, while a minimal necrosis was observed. There was no tumor recurrence in the first 6 months following the operation. In addition, we provided a high-level patient satisfaction in terms of aesthetics (Figure 2).

Figure 1.

Preoperative images of the lesion; (a) drawing border of the Limberg flap, (b) placing the flap before suture

Figure 2.

Repair of the Dermatofibrosarcoma protuberans; (a) the first post-opimage, (b) One month following the operation image

CONCLUSION

Dermatofibrosarcoma Protuberans is an extremely rare condition that can be confused with keloid, especially if growing to the size of 50 mm or not healing anyway (1, 4, 5, 7). In such cases, a detailed investigation covers core biopsy and CT-imaging to achieve an exact tissue evaluation. We suggest remembering in cases of operative or spontaneous keloid scarring lesions, and the treatment is possible after extensive resection with a flap or graft repair.