Call Us Today:
949.200.1600

Atypical Fibroxanthoma-AFX

Home > Diagnosis > Uncommon Skin Cancers > AFX

Atypical Fibroxanthoma Treatment

ABOUT ATYPICAL FIBROXANTHOMA (AFX)

Atypical Fibroxanthoma of the skin (AFX) is an uncommon tumor of sun-exposed areas of elderly white men, most commonly on the scalp and ears. This fibro-histiocytic spindle cell neoplasm has a potential to metastasize and behave aggressively. Diagnosis is made by immunohistochemistry. AFX is histologically indistinguishable from malignant fibrous histiocytoma (MFH); therefore, its clinical presentation must be used as a guide to its true behavior. Superficial lesions behave in a benign fashion and are called AFX, while lesions with subcutaneous extent or larger size have a higher tendency for lymph node and distant metastases and are called MFH. A corollary to the above also holds true. When regional metastases are found, the lesion is classified as MFH. Local recurrence can also be used to reclassify an AFX as a MFH. However, if the lesion “recurs” simply due to incomplete excision, its diagnosis should not be changed.

 

AFX has also been described as a superficial manifestation of MFH. Ronald Barr, M.D., (Dermatopathology) also believes that, comparing AFX to a superficial leimyosarcoma of the skin (SCARS Tumor Conference, 9/1/2011). The latter arises in piloerector muscles and behaves very differently than a deeper arising leiomyosarcoma that has a worse prognosis. As such, leimyosarcoma parallels behavior of AFX / MFH. A recent Mayo Clinic review of AFX found that 3.4% of these lesions transform into MFH or develop metastases within 2 years of treatment.

TREATMENT

Treatment of atypical fibroxanthoma of the skin (AFX) includes curettage and dessication (C&D), wide local excision (WLE), and Mohs micrographic surgery (MMS). Although all three are within the standard of care, the same Mayo clinic review found significant differences in recurrence rates. With Mohs micrographic surgery the recurrence was 0%, and with wide local excision it was 8.7%. WLE with 2 cm margins was recommended to ensure 96.6% clearance. However, MMS achieved cure with more tissue sparing.  A two-year follow-up is recommended after resection to monitor for regional metastases or recurrences.

 

Treatment of lesions that behave as MFH (metastatic and recurrent) is surgical resection followed by radiation therapy. The differential diagnosis for spindle cell neoplasm, such as AFX, includes spindle cell squamous cell carcinoma, dermatofibrosarcoma protuberans, and desmoplastic melanomas.

Related Articles

trichoepithelioma-histology-lateral-nasal-island-orange-county-skin-cancer-desmoplastic-series
Trichoepithelioma
HISTORY 33-year-old woman presents with 3-year history of slowly growing nasal tip lesion biopsied as a trichoepithelioma. Mohs excision was performed creating a 0.6 cm defect. It was reconstructed with a lateral nasal island flap. DISCUSSION Trichoepithelioma is a benign basaloid follicular neoplasm (arising from a pilosebaceous unit). Its basal cell proliferation is differentiated from…
Read More
recurrent-bowens-disease-squamous-cell-carcinoma-topical-chemotherapy
Recurrent Bowen’s Disease of Temple
HISTORY 63-year-old man presents with 9-month history of Bowen’s disease of right anterior and posterior sideburn biopsied on 08-20-18. History of previous Mohs excision of Bowen’s disease of the same area in February 2016. Patient has a history of multiple basal cell carcinomas, squamous cell carcinomas, and melanoma. DISCUSSION Management of this lesion is best…
Read More
scleromyxedema-cutaneous-lesions-dermatopathology-spindle-cell-basal-cell-carcinoma
Scleromyxedema Cutaneous Lesions
HISTORY 87-year-old man with underlying scleromyxedema and history of multiple basal cell carcinomas presents with a left earlobe nodule. Biopsy revealed this to be a lesion with benign spindle cell proliferation in vague concentric whorls with associated dermal fibrosis and chronic inflammation. This was a typical scleromyxedema lesion presenting within the fatty earlobe and not…
Read More
cystic-squamous-cell-carcinoma-of-forearm-keratoacanthoma-dermatopathology
Cystic Squamous Cell Carcinoma of Forearm Skin
HISTORY 74-year-old man presents with 3-month history of painful lesion of the right forearm.  Biopsy found cystic squamous cell carcinoma with deep margins involved. Wide local excision was performed achieving clear margins. DISCUSSION Cystic degeneration within squamous cell carcinoma of the skin is not considered an especially malignant finding. These histologic findings may represent changes…
Read More
anticoagulant-use-in-cutaneous-surgery-scalp-squamous-cell-carcinoma-Mohs-and-reconstruction
Anticoagulant Use in Cutaneous Surgery
HISTORY 87-year-old man with atrial fibrillation presented with squamous cell carcinoma in situ of scalp and forehead. Patient was treated with Mohs and reconstruction on 7-3-18. Incisional hematomas appeared 2.5 weeks post Mohs and treated with I&D. Patient continued warfarin and baby aspirin throughout treatments. DISCUSSION Anticoagulant use in Facial and Dermatologic Surgeries has become…
Read More
melanoma-in-situ-serial-excisions-mohs-excision-platysma-myocutaneous-flap-mapping-biopsy-orange-county-skin-cancer
Management of Recurrent Large Melanoma In Situ
HISTORY 78-year-old man presents with a recurrent melanoma in situ of left cheek in April 2018. Previously, the melanoma in situ was excised in 2001. Patient’s dermatologists performed excision in three stages over a period of 3 weeks to achieve clear margins.  Reconstruction of left cheek was performed with a cheek and neck platysma myocutaneous…
Read More

STAY UP TO DATE

Receive research updates, inspiring stories, healthy living tips and more.

Something went wrong. Please check your entries and try again.

FOLLOW US

ELEVATING THE STANDARDS OF SKIN CANCER MANAGEMENT.

© 2018 SCARS Management Services. All rights reserved.