A 56-year-old man presented for evaluation of an asymptomatic lesion on the right shoulder. This was discovered accidentally while his wife was giving him a massage.
Key point: There was a subtle 3-cm2 area of thickened nodularity on the shoulder. The lesion was better palpated than visualized. A small punch biopsy revealed this to be dermatofibrosarcoma protuberans.
Treatment: The patient’s tumor was removed easily by Mohs micrographic surgery.
Note: This tumor, often referred to as DFSP, is a low-grade soft tissue sarcoma. While metastases are uncommon (5% to 10%), local recurrence is very frequent. Excision with real-time margin control (eg, Mohs surgery) is the optimal treatment modality. An alternative treatment is simple excision with concomitant wide margin removal (5 cm minimum).