Atypical fibroxanthoma: a series of 25 cases

• Published in: Journal of the European Academy of Dermatology and Venereology 2010-08, Vol.24 (8), p.943-946
• Main Authors: Wollina, U, Schönlebe, J, Koch, A, Haroske, G
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Antigens, CD - metabolism; Antigens, Differentiation, Myelomonocytic - metabolism; atypical fibroxanthoma; Cheek; Female; Follow-Up Studies; Forehead; Humans; Male; micrographic surgery; Middle Aged; Neoplasm Recurrence, Local - prevention & control; Retrospective Studies; risk factors; sarcomas; Scalp; Skin Neoplasms - diagnosis; Skin Neoplasms - metabolism; Skin Neoplasms - surgery; Treatment Outcome; Vimentin - metabolism
• ISSN: 0926-9959; 1468-3083
• DOI: 10.1111/j.1468-3083.2010.03578.x

Objective  Atypical fibroxanthoma is a rare mesenchymal tumour of skin that develops on skin of elderly patients. We analysed our patients with atypical fibroxanthoma over the last 8 years. Patients and methods  We analysed the pathology files of our hospital for the period 2001–2009. In all cases, histology and immunohistology were performed. Data on co‐morbidities, treatment and outcome were obtained. Results  We identified 25 patients (except two female patients, the rest were men) aged 52–95 years (mean: 79.5 years; standard deviation ± 9.06 years). All tumours were localized in the head and neck region, except a single tumour on the shoulder. Fourteen patients had a cancer history, six had actinic keratoses or Bowen’s disease (n = 1). Five patients had cardiac surgery or pacemaker, one each had a renal transplant, systemic sarcoidosis or non‐Hodgkin’s lymphoma. Medical history was positive for radiotherapy or chemotherapy in four patients. Histology showed a spindle‐shaped dermal and subcutaneous tumour growth intermingled with multinucleated giant cells. The phenotype of tumour cells was vimentin‐positive, but S100‐ and keratin‐negative. Some tumours showed a focal expression of CD68. Complete microhistographic controlled surgery (‘Mohs like’) was possible in all cases followed by mesh‐graft transplantation in three patients. Eighteen patients showed a complete remission. Four patients had a relapse within 2 years of follow‐up treated by surgery. One patient is still under radiotherapy. All patients with a safety margin of 2 cm had no recurrence or relapse during follow‐up. Conclusions  Micrographic controlled surgery with wide 2 cm safety margins is the treatment of choice. A regular follow‐up for the next 5 years is recommended.