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NCCN Flash Updates: NCCN Templates Updated for Dermatofibrosarcoma Protuberans

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™) for Dermatofibrosarcoma Protuberans. These NCCN Guidelines^® are currently available as Version 1.2025.

Link directly to the Updates section of the NCCN Guidelines: Dermatofibrosarcoma Protuberans

DFSP-1

• Footnote c revised: . . .FS-DFSP is associated with a higher metastasis risk of 15%–20%. The patient should be referred to a center with expertise in management of soft tissue sarcomas. See NCCN Guidelines for Soft Tissue Sarcoma for multimodal therapy and surveillance considerations including CT of draining nodal basin and chest. (Also page DFSP-2)

DFSP-2

• Footnotes revised:
  • Footnote d: The most commonly used form of PDEMA is Mohs. See NCCN Guidelines for Squamous Cell Skin Cancer - Principles of PDEMA Technique. When anatomic structures at the deep margin (eg, major vessels, nerves, bone) preclude complete histologic evaluation of the marginal surface via Mohs or other forms of PDEMA, Mohs or other forms of PDEMA should be used to evaluate as much of the marginal surface as feasible. Treatment considerations for non-visualized areas may be the subject of multidisciplinary discussion. (Also page DFSP-3)
  • Footnote e: If PDEMA is unavailable, consider wide excision. Wide undermining is discouraged prior to confirmation of clear margins due to the difficulty of interpreting subsequent re-excised margins, and the risk of concealing residual tumor below mobilized tissue. See Principles of Surgery (DFSP-B). Curtis KK, et al. J Natl Compr Canc Netw doi: 10.6004/jnccn.2024.7036. (Also page DFSP-3)
  • Footnote h: When Mohs or other forms of PDEMA are utilized and margins are negative, RT is not recommended. When Mohs or other forms of PDEMA are not utilized, consider RT if margins are considered narrow by the treating physicians. RT can be considered for treatment of positive margins if not given previously and further resection is not feasible. (Also page DFSP-3)

DFSP-A

• Footnote 2 revised: If areas of transformation to fibrosarcoma or other sarcoma subtypes are identified, multidisciplinary consultation for consideration of further treatment and surveillance is recommended. FS-DFSP is associated with a higher metastasis risk of 15%–20%. The patient should be referred to a center with expertise in management of soft tissue sarcomas. See NCCN Guidelines for Soft Tissue Sarcoma for multimodal therapy and surveillance considerations including CT of draining nodal basin and chest.

DFSP-C

• General Treatment Information, Adjuvant RT, second sub-bullet:
  • First tertiary bullet revised: When Mohs or other forms of PDEMA are utilized and margins are negative, RT is not recommended.
  • Second tertiary bullet revised: When Mohs or other forms of PDEMA are not utilized, consider RT if margins are considered narrow <1 cm by the treating physicians, RT not given previously, and further resection 

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Drugs & Biologics Compendium (NCCN Compendium^®), the NCCN Biomarkers Compendium^®, the NCCN Chemotherapy Order Templates (NCCN Templates^®), the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), please visit NCCN.org.

To view the NCCN Guidelines for Patients^®, please visit NCCN.org/patientguidelines.

Free NCCN Guidelines apps for iPhone, iPad, and Android devices are now available! Visit NCCN.org/apps.

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