case_images: PMC11365487_01
case_images: Lesion when first consulted to Dermatology and Venereology Department (A).
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case_images: A 12-year-old girl consulted to the Dermatology and Venereology Department due to the presence of dark patch on the nasal root after finishing 25 sessions of radiotherapy (Figure 1).
case_images: Lesion during the first visit to the Oncology Surgery Department (A), lesion during wide excision operation (B and C), and postoperative lesion (D).
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case_images: The patient was initially presented to the Oncology Surgery Clinic at Hasan Sadikin General Hospital Bandung with the chief complaint of a large exophytic mass located in the nasal area, which was neither itchy nor painful (Figure 2A). August 2023, the patient underwent surgical excision combined with frontal flap performed by the Department of Surgery, Oncology Surgery Division at Hasan Sadikin General Hospital Bandung (Figure 2B-D).
case_images: Intraoperative lesion.
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case_images: A mass measuring 4x1.5x0.5 cm was excised with diagnostic frozen section examination showing suspected malignant lesion (Figure 3). A pedicle was observed after the surgery.
case_images: Lesion before pedicle excision procedure (A) and lesion after pedicle excision procedure (B).
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case_images: A second surgery was performed by Department of Surgery, Oncology Surgery Division, to excise the pedicle (Figure 4A and B).  
case_images: Histopathologic examination of DFSP consist tumor cell (A-red line), hyalinization (B-yellow arrow), cartwheel (B-red arrow), whorled pattern (C-green arrow), and fasciculus pattern (D-Orange arrow).
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case_images: Hyalinisation was seen between the tumor masses (Figure 5A-D).
case_images: Immunohistochemistry staining EMA strongly positive (A), vimentin positive in tumor cell (B), CD34 negative (C), and CK negative in tumor cell (D).
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case_images: On immunohistochemical stains, there were diffuse positivity for EMA (Figure 6A) and vimentin (Figure 6B). There was no positivity for cluster of differentiation (CD)34 (Figure 6C) and cytokeratins (CK) (Figure 6D).
case_images: Post procedure lesion day 11 (A), day 18 (B), and day 23 (C).
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