Search

Summary: Background: Dermatofibrosarcoma protuberans (DFSP) is a rare skin cancer. Standard treatment in the UK is either wide local excision (WLE) or Mohs micrographic surgery (MMS). It is unclear which approach has the lower recurrence rate. Objectives: We undertook a retrospective comparative review of surgical management of DFSP in the UK National Health Service in order to define (i) current surgical practice for primary and recurrent DFSP, (ii) local recurrence rates for primary DFSP and (iii) survival outcomes for DFSP. Methods: A retrospective clinical case‐note review of patients with histologically confirmed DFSP (January 2004 to December 2013) who have undergone surgical treatment. Results: The surgical management of 483 primary and 64 recurrent DFSP in 11 plastic surgery and 15 dermatology departments was analysed. Almost 75% of primary DFSP (n = 362) were treated with WLE and 20% (n = 97) with MMS. For recurrent DFSP, 69% (n = 44) and 23% (n = 15) of patients underwent WLE and MMS, respectively. Recurrent primary DFSP occurred in six patients after WLE and none after MMS. The median follow‐up time was 25·5 months (interquartile range 6·8–45·1) for new and 19·8 (IQR 4·5–44·5) for recurrent DFSP [Correction added on 1 Feb 2021, after first online publication: 4.8 years (interquartile range 3.5‐5.8) was incorrect], with eight reported deaths during the follow‐up analysis period (one confirmed to be DFSP related). Conclusions: WLE was the most common surgical modality used to treat DFSP across the UK. The local recurrence rate was very low, occurring only after WLE. Although a prospective randomized controlled trial may provide more definitive outcomes, in the absence of a clearly superior surgical modality, treatment decisions should be based on patient preference, clinical expertise and cost. What is already known about this topic?Surgical management of dermatofibrosarcoma protuberans (DFSP) includes wide local excision (WLE) with or without margin control.Although Mohs micrographic surgery (MMS) or similar margin‐controlled excision is advocated in the UK, this appears to be based on consensus guidance and low‐quality data, with few centres routinely providing this expertise. What does this study add?This is the largest case series of DFSP reported from the UK to date, with three‐quarters of the 483 primary DFSP treated between 2004 and 2014 being managed with WLE.Six local recurrences were found in the WLE group and none in the MMS group.In individuals with primary DFSP who underwent WLE, complete histological clearance occurred less frequently at the first attempt (81·4%) than in those who were treated with MMS (87%). Linked Comment: van denBos. Br J Dermatol 2021; 184:595. [ABSTRACT FROM AUTHOR]

Background: Incidence of non‐melanoma skin cancers (NMSCs) is increasing and can significantly impact on quality of life (QOL), yet there are few studies evaluating patient‐reported outcome measures (PROMs) in NMSC populations. We undertook a prospective feasibility study to evaluate a skin cancer‐specific PROM, the Skin Cancer Quality of Life Impact Tool (SCQOLIT), in patients with a new diagnosis of NMSC. Objectives: (i) To establish acceptability of SCQOLIT in dermatology clinics, (ii) a descriptive analysis of SCQOLIT scores in NMSC. Methods: Patients with histologically confirmed NMSC completed SCQOLIT, EQ‐5D and a transition item. Questionnaires were completed at baseline and 3 months for group 1 ('low‐risk' NMSC) and group 2 ('high‐risk' NMSC) with additional questionnaires at 6–9 months for group 2. Patients participated in structured interviews. Clinician experience was captured through staff evaluation forms and a focus group. Acceptability and psychometric properties of SCQOLIT were assessed. Results: Overall, 318 patients consented to participate. Mean SCQOLIT score at baseline was 5.33, with 2.6% of patients scoring ≥20. No ceiling effects were observed, whilst 13.9% scored 0. Validity was demonstrated against EQ‐5D. Cronbach's alpha 0.84 demonstrated internal consistency. Thirteen patients were interviewed and thought SCQOLIT was comprehensive, captured impact on health‐related QOL and helped express their needs to clinicians. Most clinicians found SCQOLIT 'very useful' or 'useful to some extent' in facilitating discussions. Conclusions: This feasibility study demonstrates that SCQOLIT is acceptable to patients and staff in dermatology skin cancer clinics. The psychometric properties of SCQOLIT confirm its utility in NMSC populations. [ABSTRACT FROM AUTHOR]

Background Volatile organic compounds ( VOCs) are continuously released by the body during normal metabolic processes, but their profiles change in the presence of cancer. Robust evidence that invasive melanoma in vivo emits a characteristic VOC signature is lacking. Objectives To conduct a canine olfactory, proof-of-principle study to investigate whether VOCs from invasive melanoma are distinguishable from those of basal cell carcinoma ( BCC), benign naevi and healthy skin in vivo. Methods After a 13-month training period, the dog's ability to discriminate melanoma was evaluated in 20 double-blind tests, each requiring selection of one melanoma sample from nine controls (three each of BCC, naevi and healthy skin; all samples new to the dog). Results The dog correctly selected the melanoma sample on nine (45%) occasions (95% confidence interval 0·23-0·68) vs. 10% expected by chance alone. A one-sided exact binomial test gave a P-value of < 0·01, supporting the hypothesis that samples were not chosen at random but that some degree of VOC signal from the melanoma samples significantly increased the probability of their detection. Use of a discrete-choice model confirmed melanoma as the most influential of the recorded medical/personal covariates in determining the dog's choice of sample. Accuracy rates based on familiar samples during training were not a reliable indicator of the dog's ability to distinguish melanoma, when confronted with new, unknown samples. Conclusions Invasive melanoma in vivo releases odorous VOCs distinct from those of BCC, benign naevi and healthy skin, adding to the evidence that the volatile metabolome of melanoma contains diagnostically useful biomarkers. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various topics within the issue on dermatology which include topics like randomized controlled trials (RCTs), RCTs in skin diseases, and evaluation of the nonpharmacological procedures used in clinical practice.

The authors reflect on the journal's efforts in expanding and strengthening its focus on clinical trials, epidemiology, and qualitative and translational research. Topics discussed include the importance of reproducibility for experimental science, the plan of the journal to consider only manuscripts reporting clinical trials that have been officially registered effective October 2015, and the principles that will guide the journal's assessment when publishing a clinical trial.

A response from R.N. Martin and H.C. Williams to a letter to the editor on an article on the comparison of Mohs micrographic surgery (MMS) and wide local excision (WLE) for the treatment of dermatofibrosarcoma protuberans (DFSP) is presented.