Surgical Approach of Pleomorphic Dermal Sarcoma on the Scalp: A Case Report

Pleomorphic dermal sarcoma (PDS) is a fast-growing mesenchymal tissue tumor with similar characteristics to an atypical fibroxanthoma (AFX) presenting a significant clinical challenge to diagnose for physicians. We report a 79-year-old male presenting with a 3-month history of a lesion on his scalp that had been previously superficially biopsied yielding a diagnosis of PDS or AFX. Following a second biopsy, new findings led to the diagnosis of PDS. A wide local excision with 2 cm margin with delayed split-thickness skin graft reconstruction was performed. Treatment for PDS favors wide local excision with a 2-3 cm margin and adjuvant radiotherapy if perineural involvement. We support the following recommendations: full-thickness appropriate tissue diagnosis, pulmonary computed tomography scan, or X-ray to rule out metastasis, followed by a multidisciplinary team evaluation. These complex cases should be presented at a tumor board and tailored treatments should be based on patient risk factors and relevant history.