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April 2009
By Kirkland Lau, DO, and Stephen M. Schleicher, MD
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CASE:
A 62-year-old woman is concerned about a rapidly enlarging lesion on her right shoulder that she first noticed six months ago. Her medical history is notable for hypertension, diabetes, and moderate sun exposure. There is no personal or family history of skin cancer.
The lesion is 1.6 cm wide, erythematous, and unaccompanied by pain, pruritus, or bleeding. The patient’s axillary nodes are nonpalpable. A biopsy is performed.
WHAT IS YOUR DIAGNOSIS? |
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The patient’s lesion is a dermatofibrosarcoma protuberans (DFSP), a rare soft-tissue malignancy that is locally aggressive. Early diagnosis of DFSP is uncommon due to its nondescript clinical appearance and relatively slow growth (this case is atypical). This neoplasm is most commonly found on the trunk and proximal extremities. Due to the likelihood of local recurrence, the treatment of choice is wide excision, possibly followed by radiation therapy. Approximately 4% of DFSPs metastasize to the regional lymph nodes or lungs, which portends a grave prognosis. |
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Dr. Lau is an associate with a division of the DermDx Centers for Dermatology in Reading, Pennsylvania. Dr. Schleicher is director of the DermDOX Center in Hazelton, Pennsylvania, a clinical instructor of dermatology at the Philadelphia College of Osteopathic Medicine and Kings College in Wilkes-Barre, Pennsylvania, and an associate professor of medicine at the Commonwealth Medical School in Scranton, Pennsylvania. He is also a member of the EMERGENCY MEDICINE editorial board.
Emerg Med 41(4):23-24, 2009
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