AB289. SOH26AB_0368. Case reports of pleomorphic dermal sarcoma excision of the head and neck from the Oral and Maxillofacial Department in University Hospital Limerick

Background: Pleomorphic dermal sarcoma (PDS) is a rare, aggressive, and malignant skin cancer that can metastasize. It is often confused with a less aggressive tumour, atypical fibroxanthoma (AFX), due to similar microscopic features. However, PDS is more aggressive and distinguished by deeper invasion into subcutaneous tissue, tumour necrosis, lymphovascular invasion, or perineural infiltration, and is shown to have 7.14% metastasis rate. According to a recently published study, there is a lack of consensus on the surgical margin of these lesions. Surgeons often prefer a surgical margin to facilitate the reconstruction of the anatomical region post-excision. There is a lack of evidence for adjuvant therapies post-excision or for the recurrence of PDS, leading to the need for re-excision at the time of presentation.

Methods: We present two cases that underwent curative excision of PDS from the scalp in the Oral and Maxillofacial Services in University Hospital Limerick in 2025. We recorded the surgical margins taken, histological margin achieved, and reconstruction performed, with the outcome of the head and neck medical decision making (MDM). This is to add to the wealth of information available for future studies of the disease. To construct a better pathway for the management of PDS for patients.

Results: Satisfactory surgical excision was achieved with a 1 cm surgical margin and shows no signs of recurrence. Head and neck MDM agreed that no further adjuvant therapies are required and clinical surveillance ± imaging of the thorax. A regular follow-up regimen is employed with clinical indication for imaging to assess for any signs of metastasis to the lungs.

Conclusions: The wound site integrated and healed well. No recurrence is noted. Clinical signs and symptoms indicated if any chest imaging is required to assess for lung metastasis.

Keywords: Pleomorphic dermal sarcoma (PDS); oral and maxillofacial; non-melanoma skin cancer; atypical fibroxanthoma (AFX); case report