More Than 2 Decades of Treating Atypical Fibroxanthoma at Mayo Clinic

BACKGROUND: Atypical fibroxanthoma (AFX) typically occurs on the head and neck of elderly white men. Usually considered a malignancy, it is treated with wide local excision (WLE) or total margin control using Mohs micrographic surgery (MMS). OBJECTIVE: To determine the most appropriate treatment for this tumor based on a review of cases treated at Mayo Clinic. METHODS: We reviewed the medical records of patients with AFX treated at Mayo Clinic from 1980 to 2004. RESULTS: We identified 91 patients with 93 tumors. Treatment information was available for 88 tumors (59 treated with MMS, 23 with WLE, and 6 by other means). There were no recurrences in the patients treated with MMS, with a median follow-up of 4.5 years (range 1.0-16.1 years). Two patients treated with WLE had single recurrences, with a median follow-up of 8.7 years (range 1.5-26.3 years). CONCLUSIONS: Total microscopic margin control using MMS was the most effective means of treating AFX.