Management of forehead dermatofibrosarcoma protuberans with wide local excision and paramedian forehead flap reconstruction: a case report

Abstract

Dermatofibrosarcoma protuberans (DFSP) is a rare, low to intermediate-grade soft tissue sarcoma that presents significant diagnostic and therapeutic challenges. We report the case of a 40-year-old male patient who presented with a slow-growing, asymptomatic lesion on his forehead that had developed over two years. Clinical examination revealed a firm, non-tender multinodular mass measuring 5 x 3 cm in the supraorbital region. The diagnosis was confirmed through histopathological examination and immunohistochemical staining, which demonstrated the characteristic storiform pattern and CD34 positivity. The patient underwent wide local excision with 3 cm margins, followed by reconstruction using a paramedian forehead flap. The procedure involved upper and lower eyelid release, lateral canthotomy, and canthoplasty to facilitate proper reconstruction. Postoperative recovery was satisfactory, though a subsequent procedure was required for further excision and secondary healing of a residual lesion. This case highlights the importance of early recognition, appropriate imaging, and the complex surgical approach often required for complete excision and reconstruction of DFSP in anatomically challenging areas. Long-term follow-up remains essential due to the high recurrence risk associated with this neoplasm.