ABSTRACT Background Pleomorphic dermal sarcoma (PDS) is a rare cutaneous sarcoma with locally aggressive behaviour and metastatic potential. Optimal surgical management remains uncertain, with both wide local excision (WLE) and Mohs micrographic surgery (MMS) used in clinical practice. This systematic review aimed to compare oncological outcomes following WLE and MMS for PDS. Methods A systematic literature search was conducted in multiple databases from inception to December 2025. Studies reporting histologically confirmed PDS treated with WLE and/or MMS and including recurrence and/or survival outcomes were eligible. Methodological quality was assessed using Joanna Briggs Institute critical appraisal tools. Results Thirteen retrospective studies comprising 543 patients were included. PDS predominantly affected elderly patients and mostly involved the head and neck, particularly the scalp. WLE was the primary surgical modality, while MMS was reported in two studies. Loc
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