Fibrosarcomatous Transformation of Recurrent Thigh Dermatofibrosarcoma Protuberans Presenting With Spontaneous Hemorrhage

Abstract

Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous sarcoma characterized by locally aggressive growth and a high rate of local recurrence. Fibrosarcomatous DFSP is an uncommon variant associated with increased risks of recurrence, metastasis, and disease-related mortality. A 32-year-old man with a history of DFSP of the left thigh presented with spontaneous life-threatening hemorrhage from a recurrent ulcerated mass. After hemodynamic stabilization, wide local excision with a 3-cm margin was performed, followed by split-thickness skin graft reconstruction. Histopathologic examination confirmed fibrosarcomatous transformation of recurrent DFSP. All surgical margins were free of tumor. The postoperative course was uneventful with satisfactory graft take and no recurrence at 5 months of follow-up. Spontaneous hemorrhage is a rare presentation of fibrosarcomatous DFSP. Prompt stabilization, oncologically sound resection, and appropriate reconstruction are essential for optimal outcomes. This case highlights the importance of recognizing aggressive clinical behavior in recurrent DFSP and emphasizes the role of reconstructive surgeons in multidisciplinary management.