Background and objectives: Atypical fibroxanthoma (AFX) is a cutaneous neoplasm, principally found in the head and neck region of elderly patients with previous sun exposure. Early recognition is vital as it can frequently mimic more invasive malignant tumours. Our aim was to review all patients presenting with this condition to our unit, in order to highlight the important characteristics of AFX.

Methods: In this retrospective study, case notes of all patients diagnosed with AFX from 1980 to 2012 were reviewed. We assessed patient demographics, presenting symptoms, appearance on clinical examination, management options, excision margins, pathology reports, and progression during follow-up. Results were compared to previous studies.

Results : 7 patients were diagnosed with AFX (6 men and 1 woman, mean age 75.9 years, range 58 to 89). The presenting complaint in all patients was a solitary lesion. 5 were found on the scalp, 1 on the forehead, and 1 on the cheek. Mean diameter was 9.8 mm (range 3–22), and depth 5.8 mm (range 3–8). The primary modes of treatment were curettage and cauterization (5 cases, of which one case had local recurrence); and complete excision (2 cases). Those that were excised were assessed to have a clearance of 5 mm in both cases, and developed no further recurrence. The most common positive immmunohistochemical markers were smooth muscle actin and vimentin.

Conclusions: We report a series of patients with a greater male: female when compared to previous literature. Curettage and cautery offers a good prognosis with low risk of recurrence and, excision with adequate clearance margins may offer a definitive management plan. Our immunohistochemistry is comparable to previous data. We aim to provoke discussion at ICOMS to increase awareness of this condition, and highlight important characteristics in order for it to be accurately identified and managed worldwide.

Key words: atypical fibroxanthoma; cutaneous neoplasm