Available online 5 December 2023, 102017

Author links open overlay panel, , , , , , AbstractBackground

Pleomorphic dermal sarcoma (PDS) of the scalp is a rare tumour which is usually slow growing, but occasionally displays rapid growth and has a low rate of local recurrence. Surgical resection is the mainstay of treatment, with or without radiotherapy. The aim of this study is to describe the surgical approach and the additional benefit of radiotherapy to the treatment of these patients.

Methods

Retrospective, single-centre analysis of patients with PDS of the scalp that underwent surgical resection between 2007-2021 (n = 24). Treatment variables including depth of resection (superficial or deep to the galea aponeurotica) and adjuvant radiotherapy were investigated.

Results

Twenty-four patients were included in this study. Median age was 80 (range, 52–95), with a median ASA score of 3 (2–3). Sixteen (66.6 %) patients underwent surgical resection including the galea, while the rest (n = 8) did not or was not known. Radiotherapy was given in 7 (29 %) patients in which only 3 (12.5 %) were in the galeal resection group. Reasons for radiotherapy administration were concomitant SCC found at the same area of resection and close margins. In a median follow-up of was 26.2 months (range, 13.6–102.5) there was only one recurrence event.

Conclusions

PDS of the scalp can be safely managed with a surgical resection if clear surgical margins are achieved without radiotherapy with good oncological outcomes.

Section snippetsBackground

Pleomorphic dermal sarcoma (PDS) is a rare, cutaneous, malignant tumour. It is usually located in the head and neck but can also be found in other locations. It is associated with sun exposure and UV radiation and is seen mostly in elderly patients [1]. PDS was recognised as an entity by the WHO in 2013, and is characterised by an atypical dermal neoplasm lacking expression of epithelial, melanocytic, vascular and muscle differentiation markers, with invasion of subcutis, presence of necrosis,

Patient selection and inclusion criteria

The study protocol was approved by our institutional Human Research Ethics Committee. A retrospective analysis of all patients who underwent surgical resection for PDS in the scalp/head between the years 2007–2021 in our center. Excluded were patients with final diagnosis of atypical fibroxanthoma or undifferentiated pleomorphic sarcoma, missing data or temporal bone lesions.

Patients' data analysis and follow-up

The analysis included patient demographics: age, sex, American Society of Anaesthesiology score (ASA score) and co-morbid

Results

A total of 29 patients received surgery at our center with a diagnosis of PDS of the scalp between the years 2007–2021. Five patients were excluded from this study due to missing data, yielding a total number of 24 patients included in the final analysis.

Discussion

This is a small series of PDS of the scalp that have been treated at our center. We have shown a low local recurrence rate at median of 26 months, among patients who underwent surgical resection, with or without adjuvant radiotherapy. We also noted that patients who underwent surgical resection that included the galea as part of their resection, had zero local recurrences without the need for additional radiotherapy. Patients who received radiotherapy were mainly patients with concomitant

Conclusions

PDS of the scalp are rare tumors that should be managed in experienced centers under the care of a multidisciplinary team. Local recurrence rates are low, regardless of the depth of surgical resection (superficial or deep to the galea) if clear surgical margins are achieved. Radiotherapy should be reserved for infiltrative tumors, such as histological galeal invasion, or in cases in which surgical resection cannot adequately achieve clear margins.

Declaration of competing interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References (34)J.C. Tardío et al.Pleomorphic dermal sarcoma: a more aggressive neoplasm than previously estimated

J. Cutan. Pathol.

(2016)

E.V. di Brizzi et al.Clinical and dermoscopic features of pleomorphic dermal sarcoma

Australas. J. Dermatol.

(2019)

T.H. McCalmontCorrection and clarification regarding AFX and pleomorphic dermal sarcoma

J. Cutan. Pathol.

(2012)

K.G. Griewank et al.Atypical fibroxanthoma and pleomorphic dermal sarcoma harbor frequent NOTCH1/2 and FAT1 mutations and similar DNA copy number alteration profiles

Mod. Pathol.

(2017)

M. Ak et al.Clinicopathological and genomic profiles of atypical fibroxanthoma and pleomorphic dermal sarcoma identify overlapping signatures with a high mutational burden

Genes

(2021)

Logan IT, Vroobel KM, le Grange F, Perrett CM. Pleomorphic dermal sarcoma: clinicopathological features and outcomes...S. Lonie et al.Management of pleomorphic dermal sarcoma

ANZ J. Surg.

(2020)

View full text

© 2023 Elsevier Ltd. All rights reserved.