When would you recommend adjuvant radiation therapy for a patient with a completely resected (negative margins) dermatofibrosarcoma protuberans?

Agree, we usually do not. Especially if these patients are completely cleared with Mohs surgery, which is found to have lower recurrence rates than WLE.

Rarely. While outcomes are excellent with combined modality treatment, the approach for DFSP is similar to that for other low grade sarcomas in that RT would be considered mainly for those who:

1. Had already recurred after a prior R0 resection;
2. Would be challenging to salvage should a recurrence later develop, e.g. due to considerations of anatomy or comorbidity;
3. Or in whom current margin status was less than secure.

Surgical resection is the preferred method of treatment for these tumors. Completely resected [negative margins] should have at least 2.5-3 cm clear margins beyond the tumor. A biopsy/resection with close margins is not an acceptable treatment. The only time I would treat these patients with postoperative radiation would be in a case where previous surgical resection has failed; the tumor has recurred and required re-resection. I do not electively treat these patients postoperative.

Not if it’s grade 1 (no fibrosarcoma component).