Atypical fibroxanthoma: Case series of 16 patients

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Abstract

Atypical fibroxanthoma is an unusual tumour of skin seen mainly in the head and neck region of elderly patients. Clinically it appears as red, ulcerated nodules, which can be difficult to differentiate from other tumours without histopathological examination. Immunohistochemical analysis also aids diagnosis. The mainstay of treatment is operation. We present a case series of 16 patients with 17 atypical fibroxanthomas over a 5-year period in a district general hospital.

Introduction

Atypical fibroxanthoma is an unusual tumour of skin seen mainly in the head and neck region of elderly patients (Fig. 1). It is often seen in those with a previous history of skin cancers of the head and neck and is thought to be associated with sun damaged or previously irradiated skin.1 It has an equal male to female ratio. Arising in the dermis, it grows fairly rapidly over a few months and is often roughly 3 cm in diameter when the patient presents for treatment. Clinically it is often red, nodular, and occasionally ulcerated, and can be extremely difficult to differentiate from other skin tumours without histopathological analysis.

Treatment is usually surgical, and Mohs micrographic surgery has sometimes been recommended. Recurrence of 5–7%2 has been reported and there are also several published case reports of metastases occurring,3 but most lesions tend to follow a relatively benign clinical course. We present a series of 17 cases of atypical fibroxanthoma seen in our hospital over a 5-year period.

Section snippets

Patients and methods

We retrospectively reviewed case notes from our hospital's pathology database of all patients with atypical fibroxanthoma treated by one surgeon, and assessed the site, size, and depth of the lesion, clearance, nearest margin, and follow up.

Results

There were 16 patients in our series (14 men and 2 women, mean age 80.4 years, range 66–90). One patient had two lesions. The size given by the pathologist was the largest diameter on macroscopic description of the histological specimen (knowing that specimens shrink by approximately 20–35% on fixation). The mean size was 19.3 mm (range 10–45). Depth of the lesion was recorded in 15 patients. Mean depth was 7 mm (range 2.5–15). All lesions were assessed as being completely excised. The mean

Discussion

The name “atypical fibroxanthoma” was first coined in 1963 by Helwig4; previously it had had several names including pseudosarcoma and paradoxical fibrosarcoma. He has also published several papers describing the core histological structure and characteristics of the lesions.4, 5 It arises from the dermis and consists of spindle-shaped cells, anaplastic cells, and bizarre multinucleated giant cells. Occasionally there can be phagocytosis of erythrocytes that leads to pigmented lesions and the

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