Surgical and Functional Considerations of Dermatofibrosarcoma Protuberans Involving Facial Nerve Danger Zones

Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive tumor, uncommonly occurring on the head and neck where these deeply infiltrating tumors might violate underlying neurovascular structures. Treatment is typically surgical, whether by Mohs micrographic surgery (MMS) or wide local excision (WLE). However, there is a paucity of literature describing functional neurologic outcomes following surgical extirpation of facial DFSP. Thus, we sought to examine the functional neurologic outcomes in patients undergoing either MMS or WLE for facial DFSP. Two patients with DFSP involving facial nerve danger zones treated by the multidisciplinary team with MMS and subsequent reconstruction were studied. Additionally, a comprehensive literature review of facial DFSP with regard to neurologic functional status was performed. From our research, only 10 of 46 patients with facial DFSP had neurologic functional status reported, with four of these cases having notable facial nerve deficits. Of our cases, both patients experienced transient neurologic deficits and neither had evidence of recurrence. The proper assessment and reporting of postoperative functional recovery should be undertaken following facial DFSP resection and consideration should be given to a multidisciplinary treatment approach.