Atypical Fibroxanthoma: A case series and review of literature.
Atypical Fibroxanthoma (AFX) is a rare cutaneous neoplasm arising from myofibroblast or fibroblast-like cells that predominantly affects the head and neck region. It commonly mimics more invasive neoplasms and is a diagnostic challenge to clinicians. The aim of this study was to develop a better understanding of AFX, focusing on recent developments in diagnosis and management.


METHODS
A retrospective case series and review of recent literature were carried out.


RESULTS
Over a 17-year period, seven cases were identified (six male, mean age at presentation was 75.9 years). Two patients underwent complete excision and five patients had curettage and cauterisation. Two patients developed local recurrence but none demonstrated signs suggestive of metastatic spread. Histologically all seven lesions displayed a spindle cell pattern. Where performed, immunohistochemical staining was positive for Vimentin, CD10, CD68 and actin, and negative for CAM 5.2, CD34, Melan-A, S100 protein, HMB45, Cytokeratin A1/A3.


CONCLUSIONS
Our patient demographics, histopathology and immunohistochemistry are comparable to previous studies. Although advances have been made in immunohistochemical analysis, we are yet to discover a specific diagnostic immunostain for AFX. Clinical findings should therefore be correlated with histology and a panel of immunohistochemical stains should be used. Given the potential for recurrence or metastases, Moh's Micrographic Surgery with regular follow-up may be the preferred management.
Epsom and St Helier University Hospitals NHS Trust, Wrythe Lane, Carshalton SM5 1AA, United Kingdom. Electronic address: smahalingam@doctors.org.uk.
Sridhayan
S
Mahalingam
North Middlesex University Hospital, Sterling Way, London N18 1QX, United Kingdom.
Aadarsh
A
Shah
Epsom and St Helier University Hospitals NHS Trust, Wrythe Lane, Carshalton SM5 1AA, United Kingdom.
Andrew
A
Stewart
D000199:Actins / Q000378:metabolism; D000368:Aged; D000369:Aged, 80 and over; D015703:Antigens, CD / Q000378:metabolism; D018952:Antigens, CD34 / Q000378:metabolism; D015214:Antigens, Differentiation, Myelomonocytic / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D002425:Cautery; D015331:Cohort Studies; D003475:Curettage; D005260:Female; D006258:Head and Neck Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007633:Keratins / Q000378:metabolism; D058965:MART-1 Antigen / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery; D009364:Neoplasm Recurrence, Local; D009372:Neoplasms, Connective Tissue / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D015260:Neprilysin / Q000378:metabolism; D012189:Retrospective Studies; D009418:S100 Proteins / Q000378:metabolism; D012535:Scalp / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D012878:Skin Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D014746:Vimentin / Q000378:metabolism; D000097382:CD68 Molecule
D000199:Actins; D015703:Antigens, CD; D018952:Antigens, CD34; D015214:Antigens, Differentiation, Myelomonocytic; D015415:Biomarkers; D007633:Keratins; D058965:MART-1 Antigen; D015260:Neprilysin; D009418:S100 Proteins; D014746:Vimentin; C400901:CAM 5.2 antigen; C067980:CD68 antigen, human; D000097382:CD68 Molecule; C548667:MLANA protein, human
AFX; Atypical Fibroxanthoma