Atypical fibroxanthoma: clinicopathologic determinants for recurrence and implications for surgical management

Atypical fibroxanthoma (AFX) is an uncommon skin tumor occurring primarily in the head and neck region of elderly Caucasian males. Treated with local excision, the disease is thought to be fairly benign but can occasionally demonstrate aggressive local recurrence as well as distant metastasis.

Seventy-one cases of AFX were reviewed, representing all patients presenting to the Health Sciences Centre of South Eastern Ontario with the diagnosis of AFX in the period 1989-2008. Demographic and pathologic data were obtained from patient charts for analysis.

Mean age at presentation was 76, with a male:female ratio of 4:1. Recurrence occurred in 10 patients after an average period of 7.3 months. Three recurrent lesions went on to distant metastasis, on average 14.3 months after initial presentation. The remaining 60 tumors did not recur. Histologically, tumor extending beyond the dermis into the underlying adipose and muscular tissue had a 29.4% chance of local recurrence and an 11.8% chance of metastasis compared to lesions confined to the dermis only (9.3% and 1.8%).

While the majority of AFX presentations are benign, there is a real possibility of metastatic spread. Invasion beyond the dermis and a rapid rate of recurrence are suggestive of a more aggressive clinical course.