Considerations for Tissue Expansion in the Management of Massive Dermatofibrosarcoma Protuberans of the Head and Neck

Objective: Dermatofibrosarcoma protuberans (DFSP) is a locally invasive soft tissue tumor with rare malignant potential, but a high tendency for local recurrence. We present 2 cases of DFSP involving the head and neck requiring tissue expansion for reconstruction. Methods: A retrospective review of the medical records for 2 patients with DFSP was performed. Data concerning the operative approaches, reconstructive strategies, details of tissue expansion, and outcomes were collected. Results: Case 1: A 4-year-old child with a large DFSP infiltrating her entire anterolateral neck and shoulder. Case 2: A 34-year old woman with a large DFSP involving the scalp overlaying the anterior-frontal scalp. Both patients underwent successful tumor resection and reconstruction; however, the timing of tissue expander placement and final reconstruction differed. Conclusions: These cases present the challenges of soft tissue reconstruction of the head and neck following tumor extirpation. In addition, we discuss the important considerations for tissue expansion prior to tumor resection versus after tumor resection and free flap reconstruction.