Atypical fibroxanthoma: Case series of 16 patients
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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Cited by (13)
Atypical fibroxanthoma: Systematic review and meta-analysis of treatment with Mohs micrographic surgery or excision
2018, Journal of the American Academy of DermatologyCitation Excerpt :In addition, 17 metastases were in the WLE group, for a metastatic rate of 1.0% (95% CI 0.2%-1.9%). No local recurrence or metastasis developed in the immunocompromised MMS subgroup (0/11); however, 4 of 10 (40%) recurred and 1 of 10 (10%) metastasized in the WLE immunocompromised subgroup.4,32 A high degree of protocol variability or heterogeneity was found in the WLE group, with an I2 of 73.6% (P < .001) (Fig 3).1,4-6,20-32,34-38
Full length articles published in BJOMS during 2010-11 - An analysis by sub-specialty and study type
2012, British Journal of Oral and Maxillofacial SurgeryAtypical fibroxanthoma - A retrospective immunohistochemical study of 42 cases
2012, Journal of Oral and Maxillofacial SurgeryOral and maxillofacial surgery: "publication hot spots" in the United Kingdom
2012, British Journal of Oral and Maxillofacial SurgeryA synopsis of head and neck oncology and related papers published in the British Journal of Oral and Maxillofacial Surgery in 2009/10
2011, British Journal of Oral and Maxillofacial SurgeryCitation Excerpt :The management of various interesting, though rare, tumours have been published in BJOMS. These included a systematic review of para-neoplastic syndromes associated with oral cancers,19 and case series on chondrosarcomas,20 atypical fibroxanthomas21 and Merkel cell carcinomas.22 Zhang et al.23 presented a long-term follow-up study on ameloblastomas in children and adolescents.
Immunohistochemical Characteristics of Atypical Fibroxanthoma and Pleomorphic Dermal Sarcoma: A Systematic Review and Meta-Analysis
2022, American Journal of Dermatopathology