Clinical and Dermoscopic Spectrum of Dermatofibrosarcoma Protuberans in Fitzpatrick Skin Phototype III: A Four-Case Series
M. Moustaoui *
Department of Dermatology-Venereology, Mohammed V University, Ibn Sina University Hospital, Rabat, Morocco.
S. Hamada
Department of Dermatology-Venereology, Mohammed V University, Ibn Sina University Hospital, Rabat, Morocco.
H. El Hassani Taib
Department of Dermatology-Venereology, Mohammed V University, Ibn Sina University Hospital, Rabat, Morocco.
M. Chaouqi
Department of Dermatology-Venereology, Mohammed V University, Ibn Sina University Hospital, Rabat, Morocco.
L. Benzekri
Department of Dermatology-Venereology, Mohammed V University, Ibn Sina University Hospital, Rabat, Morocco.
M. Meziane
Department of Dermatology-Venereology, Mohammed V University, Ibn Sina University Hospital, Rabat, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Background: Dermatofibrosarcoma protuberans (DFSP) is a rare, slow-growing cutaneous sarcoma characterised by locally aggressive behaviour and a high risk of local recurrence. Its variable clinical presentation may mimic several benign and malignant cutaneous lesions. Dermoscopy can provide useful diagnostic clues, although no single feature is specific.
Objective: To describe the clinical and dermoscopic characteristics of DFSP in patients with Fitzpatrick skin phototype III.
Methods: We retrospectively describe four histopathologically confirmed cases of DFSP, all occurring in patients with Fitzpatrick skin phototype III. Clinical and dermoscopic findings were assessed and compared with previously reported dermoscopic features.
Results: The patients were aged 19–47 years and included three women and one man. Lesions were located on the trunk and proximal lower extremities and presented as pink or brownish plaques, nodules, or hypertrophic lesions, including one recurrence within a surgical graft scar. Dermoscopy consistently demonstrated arborising or linear vessels, a pink background, and white structureless or shiny areas in all four cases. A pigment network was observed in two cases, while yellowish structureless areas were present in three. The recurrent lesion showed prominent thick arborising vessels over an erythematous fibrotic background. These findings support a multicomponent dermoscopic pattern involving vascular, pigmentary, and fibrotic structures.
Conclusion: DFSP exhibits considerable clinical and dermoscopic variability, which may contribute to diagnostic delay. In our series, the combination of arborising or linear vessels, a pink background, and white structureless or shiny areas represented the most consistent dermoscopic pattern. Although none of these findings is pathognomonic, their combination may raise suspicion of DFSP and prompt histopathological confirmation. Larger studies are needed to clarify the influence of skin phototype on DFSP dermoscopy.
Keywords: Dermatofibrosarcoma protuberans, Dermoscopy, Cutaneous sarcoma, Skin phototype, Arborizing vessels