title: Clinical spectrum of atypical fibroxanthoma and undifferentiated pleomorphic sarcoma in solid organ transplant recipients: a collective experience.
abstract: BACKGROUND
  Atypical fibroxanthoma (AFX) and undifferentiated pleomorphic sarcoma (UPS) are uncommon, spindle cell cutaneous malignancies. Solid organ transplant recipients (SOTRs) are immunosuppressed and therefore have a higher incidence of cutaneous malignancies.
  
  
  OBJECTIVE
  We describe the clinical spectrum of AFX and a more-aggressive, deeper variant, UPS, in SOTRs.
  
  
  METHODS
  A retrospective chart review of AFX and UPS in SOTRs was implemented. Cases from Vanderbilt University, Emory University, Mayo Clinic-Jacksonville, and University of Rochester were included. A literature search included previously published cases.
  
  
  RESULTS
  The average age of SOTRs at time of tumor presentation was younger than typically seen in immunocompetent patients for AFX. Rates of local recurrences and metastases were higher in the SOTRs than is noted in the immunocompetent literature. Rates of recurrence were higher in those treated with excision than in those treated with Mohs micrographic surgery (MMS).
  
  
  CONCLUSIONS
  AFX and UPS may have a greater risk for recurrence, metastases, and mortality in SOTRs, in whom early treatment with MMS may demonstrate certain advantages in terms of minimizing risk of recurrence and metastasis. UPS and recurrent tumors should be staged appropriately and may respond to adjuvant radiation therapy and reduction of immunosuppression. Immunohistochemical evaluation is recommended to exclude other spindle cell tumors.
authors: Department of Dermatology, Emory University, Atlanta, Georgia 30322, USA.
authors: Holly H
authors: HH
authors: McCoppin
authors: Daniel
authors: D
authors: Christiansen
authors: Thomas
authors: T
authors: Stasko
authors: Carl
authors: C
authors: Washington
authors: Juan Carlos
authors: JC
authors: Martinez
authors: Marc D
authors: MD
authors: Brown
authors: Fiona O
authors: FO
authors: Zwald
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016027:Heart Transplantation / Q000276:immunology*; D018219:Histiocytoma, Benign Fibrous / Q000209:etiology* / Q000276:immunology / Q000556:secondary / Q000628:therapy; D051677:Histiocytoma, Malignant Fibrous / Q000209:etiology* / Q000276:immunology / Q000473:pathology / Q000556:secondary; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000276:immunology*; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012878:Skin Neoplasms / Q000209:etiology* / Q000276:immunology / Q000473:pathology / Q000628:therapy