Forehead dermatofibrosarcoma protuberans treated exclusively with full-thickness skin grafting: a unique case report and review of the literature

Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive cutaneous sarcoma. Forehead involvement is uncommon and poses significant reconstructive challenges due to complex aesthetic and functional demands. Most reported reconstructions utilize staged flaps or tissue expansion. To the best of our knowledge and based on a comprehensive literature review, there are no previous reports specifically documenting forehead DFSP reconstruction performed exclusively with full-thickness skin grafting (FTSG) following wide local excision.We report a case highlighting this technique's reconstructive and aesthetic advantages. A 50-year-old woman presented with a long-standing, enlarging paramedian forehead mass above the right eyebrow, measuring approximately 7.5 × 6.5 cm. A punch biopsy and imaging confirmed DFSP. Wide local excision with 3 cm margins was performed, resulting in a 10.5 × 9 cm defect. Reconstruction was achieved using a single-stage FTSG harvested from the suprapubic region, including a segment of hair-bearing skin aligned to restore the forehead hairline. At 10 month follow-up, the patient had full graft take, preserved frontalis function, and satisfying aesthetic outcome with no recurrence. Forehead DFSP reconstruction typically involves complex, multi-stage flap procedures that risk distortion of key facial landmarks and increased morbidity. Our case demonstrates that immediate full-thickness skin grafting offers a simpler, single-stage alternative preserving eyebrow position, facial symmetry, and function. Harvesting the graft from the suprapubic area, utilizing a prior cesarean scar, allowed restoration of the hairline with hair-bearing skin-an innovative aesthetic advantage not previously reported. This unique case demonstrates that FTSG can provide favorable aesthetic and functional outcomes in selected forehead DFSP cases, representing a valuable addition to reconstructive options.