Navigating the Uncommon: Inguinal Metastasis in Dermatofibrosarcoma Protuberans

Abstract Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive soft tissue sarcoma with a low rate of metastasis, affecting around four per million annually. Representing about 1% of sarcomas, often manifests on the trunk or proximal extremities. Most cases are low-grade, but some have a high-grade fibrosarcomatous component, which is linked to a higher risk of recurrence and metastasis. Here, we present a 55-year-old male with DFSP, initially presenting as a non-healing ulcer on his foot. Despite surgical excision, radiotherapy, and chemotherapy with imatinib, the patient developed a recurrent ulcer and calcaneum involvement, leading to below-knee amputation. One year later, inguinal lymph node metastasis was detected. After inguinal lymph node dissection and additional radiotherapy, the patient showed no further active lesions. This case highlights the rarity of lymph node metastasis in DFSP and the ongoing need for research into optimal management strategies.