TY - JOUR
T1 - Atypical Fibroxanthoma
T2 - The Washington University Experience
AU - Phelan, Patrick S.
AU - Rosman, Ilana S.
AU - Council, M. Laurin
N1 - Funding Information:
Supported in part by Washington University School of Medicine in St. Louis through the Office of Medical Student Research Dean’s Fellowship. Preliminary results presented in poster form at the American College of Mohs Surgery 49th Annual Meeting; April 27-29, 2017; San Francisco, CA, and Washington University School of Medicine in St. Louis Research Training Symposium and Poster Session; October 20, 2016; St. Louis, MO. M. L. Council has served as an adviser to MDoutlook, LLC, and Medline Industries, Inc. The remaining authors have indicated no significant interest with commercial supporters.
Publisher Copyright:
© 2019 by the American Society for Dermatologic Surgery, Inc.
PY - 2019/12/1
Y1 - 2019/12/1
N2 - BACKGROUND A typical fibroxanthoma (AFX) is a rare dermal neoplasm typically occurring on sun-exposed skin in the elderly. As AFX remains a diagnosis of exclusion, updated characterization and treatment assessments are necessary to support informed diagnosis and management.OBJECTIVECharacterization of contemporary AFX and surgical outcomes by Mohs micrographic surgery (MMS) and conventional local excision (LE).METHODSRetrospective cohort analysis of all cases of AFX at our institution from January 2000 through July 2016.RESULTSAmong 75 cases with median age at diagnosis 73 years, most occurred on the head and neck (68) independent of age. Most treated cases (42) underwent MMS alone, with median tissue removal greater for LE (2.6 cm, 4.5 cm2) than MMS (0.6 cm, 1.2 cm2). Over a median 26 months of follow-up, 6 recurrences were observed among 50 cases, with metastases in 2 cases. Intent-to-treat recurrence rates were 3.4% for MMS and 25% for LE. One nonrecurrent and 2 recurrent cases received revised diagnoses after initial treatment, yielding a true recurrence rate of 8.5%.CONCLUSIONDespite diagnostic confounding by similar pathologies, surgical treatment of AFX remains effective. Tissue-sparing resection by MMS affords the potential for cosmetic and reconstructive advantage, without compromising recurrence compared with conventional excision.
AB - BACKGROUND A typical fibroxanthoma (AFX) is a rare dermal neoplasm typically occurring on sun-exposed skin in the elderly. As AFX remains a diagnosis of exclusion, updated characterization and treatment assessments are necessary to support informed diagnosis and management.OBJECTIVECharacterization of contemporary AFX and surgical outcomes by Mohs micrographic surgery (MMS) and conventional local excision (LE).METHODSRetrospective cohort analysis of all cases of AFX at our institution from January 2000 through July 2016.RESULTSAmong 75 cases with median age at diagnosis 73 years, most occurred on the head and neck (68) independent of age. Most treated cases (42) underwent MMS alone, with median tissue removal greater for LE (2.6 cm, 4.5 cm2) than MMS (0.6 cm, 1.2 cm2). Over a median 26 months of follow-up, 6 recurrences were observed among 50 cases, with metastases in 2 cases. Intent-to-treat recurrence rates were 3.4% for MMS and 25% for LE. One nonrecurrent and 2 recurrent cases received revised diagnoses after initial treatment, yielding a true recurrence rate of 8.5%.CONCLUSIONDespite diagnostic confounding by similar pathologies, surgical treatment of AFX remains effective. Tissue-sparing resection by MMS affords the potential for cosmetic and reconstructive advantage, without compromising recurrence compared with conventional excision.
UR - http://www.scopus.com/inward/record.url?scp=85075805247&partnerID=8YFLogxK
U2 - 10.1097/DSS.0000000000001943
DO - 10.1097/DSS.0000000000001943
M3 - Article
C2 - 30939522
AN - SCOPUS:85075805247
SN - 1076-0512
VL - 45
SP - 1450
EP - 1458
JO - Dermatologic Surgery
JF - Dermatologic Surgery
IS - 12
ER -