Perioperative care: dermatofibrosarcoma protuberans: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Perioperative care: dermatofibrosarcoma protuberans

Sample item

A 35-year-old man has a slowly growing firm plaque on the trunk that has recurred twice after simple excision. Histology shows spindle cells in a storiform pattern infiltrating subcutaneous fat, positive for CD34. What is the preferred treatment?

ASystemic doxorubicin chemotherapyBWide local excision with clear marginsCSentinel node biopsy with completion lymph node dissectionDSimple re-excision with a 5 mm margin

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Wide local excision with clear margins

Dermatofibrosarcoma protuberans is a locally aggressive dermal sarcoma with finger-like extensions and a high local recurrence rate, but nodal and distant spread are rare. Treatment is wide local excision with histologically clear margins, or Mohs surgery, and imatinib is used for unresectable disease.

Option by option

A. Systemic doxorubicin chemotherapy
Chemotherapy has a limited role, because the disease is controlled by surgery.
B. Wide local excision with clear margins (correct)
Correct. Wide excision with clear margins controls the infiltrative edges.
C. Sentinel node biopsy with completion lymph node dissection
Nodal spread is rare, so nodal surgery is not needed.
D. Simple re-excision with a 5 mm margin
A narrow re-excision is what led to recurrence in this patient.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is B, Wide local excision with clear margins. Dermatofibrosarcoma protuberans is a locally aggressive dermal sarcoma with finger-like extensions and a high local recurrence rate, but nodal and distant spread are rare.

Why is "Systemic doxorubicin chemotherapy" not the answer?

Chemotherapy has a limited role, because the disease is controlled by surgery.

Why is "Sentinel node biopsy with completion lymph node dissection" not the answer?

Nodal spread is rare, so nodal surgery is not needed.

Why is "Simple re-excision with a 5 mm margin" not the answer?

A narrow re-excision is what led to recurrence in this patient.

What concept does this question test?

It tests Perioperative care: dermatofibrosarcoma protuberans in General Surgery. Treatment is wide local excision with histologically clear margins, or Mohs surgery, and imatinib is used for unresectable disease.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Perioperative care: dermatofibrosarcoma protuberans?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.