Atypical fibroxanthoma: Systematic review and meta-analysis of treatment with Mohs micrographic surgery or excision

Tolkachjov, Stanislav N.; Kelley, Benjamin; Alahdab, Fares; Erwin, Patricia J.; Brewer, Jerry D.

doi:10.1016/j.jaad.2018.06.048

Cited by 46 publications

(47 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…There are recent review papers on AFX that estimate metastasis risk of this tumour on 0.5% or 1.9% for wide local excision and 3.2% or 1% for Mohs micrographic surgery. 3,22 Nevertheless, it should be noted that these reviews include neoplasms with no careful histopathological analysis reported. As in our study, metastases attributable to AFX were not detected in the largest reported series of AFX, including 171 tumours.…”

Section: Discussionmentioning

confidence: 99%

Incidence rate and clinicopathological features of 62 atypical fibroxanthomas in a North‐Western Spanish population

et al. 2019

View full text Add to dashboard Cite

Background/Objectives Atypical fibroxanthoma (AFX) is a mesenchymal neoplasm of unknown incidence. It has been determined that AFX is a tumour with low aggressiveness as long as it is properly diagnosed. Our objectives were to exclude pleomorphic dermal sarcomas or other skin tumours incorrectly diagnosed as AFX in our centre after applying strict diagnostic criteria and to assess the behaviour of appropriately diagnosed AFX. Methods We conducted an observational retrospective analysis of 73 patients diagnosed with AFX in our centre between 1998 and 2018. After selecting cases fulfilling AFX criteria, we made an analysis of predictive factors for local recurrence. Crude and sex‐adjusted incidence rates were calculated. Results Out of 73 cases, 62 were eventually diagnosed as AFX. We examined for absence of tumour necrosis, lymphovascular or perineural invasion and infiltration of deep structures. Cytokeratin AE1‐AE3, desmin and CD34 were negative in all cases. The remaining tumours were reclassified. The incidence of AFX in our health‐care area was estimated at 0.59 cases every 100 000 inhabitants per year. In our series, 72.6% of the patients were men with mean age at diagnosis of 81 years. Average tumour diameter was 12 mm. The most common location was head and neck (96.8%). Only four local recurrences were detected over a mean of 47‐month follow‐up. Conclusions We report a series of AFX in our health‐care area. We verify its indolent course when it is properly diagnosed.

show abstract

Section: Discussionmentioning

confidence: 99%

Incidence rate and clinicopathological features of 62 atypical fibroxanthomas in a North‐Western Spanish population

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Cryotherapy is not recommended due to the risk of recurrence or metastasis, and irradiation poses the risk of causing tumor DNA dysregulation, resulting in progression to a more aggressive tumor [ 16 ]. A meta-analysis of 23 studies comparing treatment with Mohs micrographic surgery to excision for atypical fibroxanthoma suggested that Mohs surgery was associated with a lower recurrence rate than wide local excision [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, clinically distinguishing the two cutaneous diseases is often difficult because of the similarities in their gross and microscopic morphologies. Several studies support the treatment of AFX with Mohs surgery [ 12 - 15 ] but less is known about the treatment of the more aggressive PDS variant.…”

Section: Introductionmentioning

confidence: 99%

Pleomorphic Dermal Sarcoma of the Scalp

Klebanov¹,

Hoang²,

Reddy³

2018

Cureus

View full text Add to dashboard Cite

Pleomorphic dermal sarcoma (PDS) is a rare mesenchymal tissue tumor. Distinguishing PDS from similar conditions, such as atypical fibroxanthoma (AFX), its less aggressive tumor counterpart, is difficult, as they are clinically and histologically similar. We present a case of a 77-year-old man presenting with a large nodular scalp lesion of three weeks duration. Pathology revealed a 3.3 cm invasive pleomorphic dermal sarcoma. Surgical excision with 2 cm margins was performed with successful healing of the graft. This case highlights a rare case of a large pleomorphic dermal sarcoma and discusses the histological features and management of PDS.

show abstract

“…Mohs micrographic surgery (MMS) and wide local excision (WLE) are two surgical options for the management of AFX, with limited comparative data available to date exploring their relative safety and efficacy. Although recent systematic reviews have compared MMS versus WLE for the treatment of AFX, their conclusions with regard to recurrence rates are different. Furthermore, one factor which has not been addressed is the timing of recurrence following surgical excision of AFX, and whether the time to recurrence differs between MMS versus WLE technique.…”

Section: Introductionmentioning

confidence: 99%

Time to recurrence after surgical excision of atypical fibroxanthoma‐updated systematic review and meta‐analysis

Phan

Onggo

2019

Aust J Dermatology

View full text Add to dashboard Cite

Atypical fibroxanthoma (AFX) remains a rare cutaneous dermally based fibrohistiocytic tumour with high rates of local recurrence. Mohs micrographic surgery (MMS) and wide local excision (WLE) with margins 1-2 cm are two surgical options. It is unclear whether timing of recurrence following surgical excision of AFX differs according to technique. A systematic review and meta-analysis were performed according to PRISMA guidelines. There was a total of 188 MMS cases and 783 WLE cases. The pooled proportion of MMS cases of recurrence is 6.6% (95% CI 3.6-11.9%), compared with WLE 11.3% (95% CI 7.1-16.5%), which was not significantly different (P = 0.12) Pooled time to recurrence of MMS for AFX to be 14.2 (95% CI 11.6-16.8%) months, compared to 13.3 (95% CI 9.99-16.6%) months (P = 0.86). Our findings suggest that recurrence rates are similar between MMS and WLE techniques and that timing of recurrence is similar regardless of surgical technique employed.

show abstract

Atypical fibroxanthoma: Systematic review and meta-analysis of treatment with Mohs micrographic surgery or excision

Cited by 46 publications

References 33 publications

Incidence rate and clinicopathological features of 62 atypical fibroxanthomas in a North‐Western Spanish population

Incidence rate and clinicopathological features of 62 atypical fibroxanthomas in a North‐Western Spanish population

Pleomorphic Dermal Sarcoma of the Scalp

Time to recurrence after surgical excision of atypical fibroxanthoma‐updated systematic review and meta‐analysis

Contact Info

Product

Resources

About