Hindawi Publishing Corporation Obstetrics and Gynecology International Volume 2009, Article ID 547672, 2 pages doi:10.1155/2009/547672 Case Report Mohs Micrographic Surgery for Dermatoﬁbrosarcoma Protuberans of the Vulva K. Doufekas,1 T. J. Duncan,1 K. M. Williamson,1 S. Varma,2 and D. Nunns1 1 Department of Gynaecological Oncology, Nottingham City Hospital, Nottingham NG5 1PB, UK 2 Department of Dermatology, Queens Medical Centre, Nottingham NG7 2UH, UK Correspondence should be addressed to D. Nunns, david.nunns@nuh.nhs.uk Received 7 May 2009; Accepted 3 August 2009 Recommended by William T. Creasman Introduction. Dermatoﬁbrosarcoma Protuberans (DFSP) is a rare cutaneous tumour of low/intermediate malignant potential, which occasionally arises on the vulva. Historically, the treatment has been wide local excision (WLE). Mohs micrographic surgery (MMS) is now recommended to ensure precise margin control. MMS to treat DFSP of the trunk and extremities is well documented. However, no report to date has described its use in vulval DFSP. Case History. A 39 year old woman presented with a longstanding nodule in the left labium majus. Histology after surgical removal showed an incompletely excised DFSP. MMS was undertaken with primary closure of the defect. Three years following treatment there is no evidence of recurrence. Discussion. The local recurrence rate of DFSP after WLE ranges from 0–75%. Finger-like projections from DFSP into surrounding tissue often results in incomplete excision. Representative vertical sections used in WLE assess less than 1% of the total tumour margin. MMS uses systematic horizontal sectioning. 100% of the tumour margin is microscopically examined. MMS is now advocated to ensure precise margin control. Copyright © 2009 K. Doufekas et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 1. Introduction Dermatoﬁbrosarcoma protuberans (DFSP) is a rare cuta- neous tumour of low / intermediate malignant potential, which occasionally arises in the vulva. Historically, the treatment has been wide local excision (WLE). However, local recurrence rates after WLE are high [1]. Microscopic projections of the tumour into surrounding tissue often extend beyond the central nodule, resulting in incomplete excision [2, 3]. Mohs Micrographic Surgery (MMS) oﬀers an alternative therapeutic approach. MMS allows mapping of the extend of DFSP with microscopic examination of its deep and lateral margins. 100% of the tumour margin is examined. The microscopic tumour projections into surrounding tissue are reliably identiﬁed and excised. Favourable outcomes are reported with preservation of tissue and a low recurrence rate [1]. MMS to treat DFSP of the trunk and extremities is well documented [1]. However, no report to date has described its use in DFSP of the vulva. 2. Case History A-39-year old woman presented with a longstanding painless nodule in the left labium majus. Histology after surgical removal showed an incompletely excised DFSP. Chest X-Ray showed no evidence of metastasis. Further management involved a multidisciplinary team, consisting of a dermatologist, gynaecological oncologist, and histopathologist. A residual 10–15 mm nodule was ﬁrst debulked under local anaesthetic. MMS was then undertaken. A highly specialized and accurate protocol of surgical technique were followed. Anatomic orientation of the specimen was deﬁned and drawn onto a map. The specimen was then sliced so that deep and lateral margins lay in the same plane. Horizontal frozen sections were stained with haematoxylin and eosin and examined microscopically to provide a complete 360 degree view of the tumour margins. With MMS the micro- scopic projections into surrounding tissue can be identiﬁed. Residual tumour is then depicted onto the previously drawn