Autoamputating dermatofibrosarcoma protruberans
Jebastin J, Pimentel J, and Perry K. Autoamputating dermatofibrosarcoma protruberans. Am J Dermatopathol 2018; 40(6):e85.
Am J Dermatopathol
This case is a 31 year old healthy female who presented with a skin lesion of several years, slowly increasing in size that had spontaneously fallen off her back. Previously, an outside institution determined this was a keloid, but no biopsy was performed. On examination, there was a 2 • 2 cm circular wound with mild bleeding on her back with adjacent nodularity, but no surrounding erythema. The detached lesion was a 2 • 2 • 0.5 cm flesh colored cauliflower form mass with a clean base. The clinical impression was dermatofibroma, keloid or melanoma among others. Microscopically, the detached portion was a CD34-positive dermal spindle cell proliferation with a fascicular and storiform pattern and a positive deep margin, consistent with dermatofibromaprotuberans (DFSP). Due to the large size and indistinct clinical borders, Mohs micrographic surgery with three stages and a total of 51 sections was performed to ensure complete removal of the tumor. DFSP usually presents as a slow growing papule or nodule which can show necrosis, hemorrhage and accelerated growth, but autoamputation has not been described in the English literature.