Atypical fibroxanthoma - Hair and Scalp
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Synopsis
AFX may occur in individuals of any race, but most cases have been reported in individuals of Northern European descent. There is a male sex predilection.
Ultraviolet (UV) light exposure is considered a major risk factor for the development of AFX. Other proposed risk factors are radiation exposure, immunosuppression, burns, and trauma. Of note, the incidence of AFX in transplant patients is as high as 78 per 100 000 patients.
AFX carries a good prognosis overall. Recurrences typically occur within the first 3 years. Based on a review of 1500 published cases, the overall recurrence rate was 7.6%. Metastasis is rare, but when it occurs, the lymph nodes are often the first site of involvement. In this same review, the disease-specific survival was 98% at 5, 10, and 20 years.
Pediatric Patient Considerations:
A few cases of AFX have been reported in children with xeroderma pigmentosum.
Codes
ICD10CM:C49.9 – Malignant neoplasm of connective and soft tissue, unspecified
SNOMEDCT:
254754005 – Atypical fibroxanthoma of skin
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Differential Diagnosis & Pitfalls
- Dermatofibrosarcoma protuberans
- Amelanotic melanoma
- Squamous cell carcinoma
- Merkel cell carcinoma
- Basal cell carcinoma
- Lobular capillary hemangioma (pyogenic granuloma)
- Cutaneous metastasis
- Basosquamous carcinoma
- Undifferentiated pleomorphic sarcoma
- Pleomorphic dermal sarcoma (PDS) – Intermediate in biologic behavior between AFX and undifferentiated pleomorphic sarcoma, PDS involves the subcutaneous tissue, may extend to muscle or fascia, and shows perineural or vascular invasion.
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Last Reviewed:07/20/2020
Last Updated:07/28/2020
Last Updated:07/28/2020
Atypical fibroxanthoma - Hair and Scalp
See also in: Overview