title: The evolving conception and management challenges of malignant fibrous histiocytoma.
abstract: BACKGROUND
  Malignant fibrous histiocytoma (MFH) is a rare and aggressive tumor. Mohs micrographic surgery (MMS) has been reported as an effective treatment, although most cases were published before advances in cytopathologic techniques led to reclassification of many tumors.
  
  
  OBJECTIVE
  To evaluate a contemporary cohort of individuals with MFH and analyze management practices.
  
  
  METHODS
  We reviewed all cases of MFH diagnosed at our institution from January 1995 to December 2010, evaluating 839 records to identify 36 patients undergoing management of tumors of the head and neck.
  
  
  RESULTS
  Seventeen of the total 36 patients (47%; mean age 67) experienced tumor recurrence, and 10 (28%) developed metastases. Seven of nine patients initially treated with MMS (78%), and 10 of 24 (42%) treated with WLE experienced recurrence (p = .06). Patients treated with MMS had smaller tissue defects after surgery. The mean contemporary recurrence rate of MFH treated with MMS is significantly higher (58.8%) than the cumulative recurrence rate reported before 2000 (7.4%) (p < .001).
  
  
  CONCLUSIONS
  Our study is consistent with reports of MFH as an aggressive neoplasm and describes the largest population treated with MMS in 3 decades. The changing conception of MFH, along with a propensity for in-transit metastases, may explain higher contemporary recurrence rates.
authors.affiliation: Department of Dermatology, Stanford University, 360 Stanford Ave., Palo Alto, CA 94306, USA. tylerhollmig@gmail.com
authors.forename: S Tyler
authors.initials: ST
authors.lastname: Hollmig
authors.forename: E Brent
authors.initials: EB
authors.lastname: Kirkland
authors.forename: Michael T
authors.initials: MT
authors.lastname: Henderson
authors.forename: Jean Y
authors.initials: JY
authors.lastname: Tang
authors.forename: Hayes B
authors.initials: HB
authors.lastname: Gladstone
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D051677:Histiocytoma, Malignant Fibrous / Q000175:diagnosis / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery; D009364:Neoplasm Recurrence, Local; D012878:Skin Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D055815:Young Adult