Atypical Fibroxanthoma Clinical Presentation

Updated: Oct 14, 2020
  • Author: Forrest C Brown, MD; Chief Editor: William D James, MD  more...
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Typically, the patient presenting with atypical fibroxanthoma (AFX) is an older individual (mean age 69 y) with sun-damaged or radiation-damaged skin of the head, neck, and scalp.


Physical Examination

Nodules are red, juicy, and dome shaped and they may be ulcerated, as in the image below. Lesions are usually located on skin that is red, thin, and telangiectatic, indicating previous significant sun or radiation damage. Some nodules are dark enough, due to deposits of hemosiderin, to be confused with a nodular melanoma.

Red, beefy, sessile nodule typical of clinical pre Red, beefy, sessile nodule typical of clinical presentation of atypical fibroxanthoma. Note the markedly sun-damaged skin with solar telangiectasias. Courtesy of Capt James Steger, MC, USN, US Naval Hospital, San Diego.

Nodules primarily are located on the head and neck and in sun-exposed areas. In addition, lesions have been reported to occur on the trunk, extremities, and in sun-protected areas. The ratio of lesions that occur on the head and neck to lesions that occur in other areas is approximately 4:1.

Tumor size increases proportionately with duration of existence but rarely exceeds 3 cm in diameter. Lesion growth typically is rapid, and patients usually seek medical advice within 6 months of onset.

In adult cases, the skin underlying developing atypical fibroxanthoma (AFX) lesions may be considered locally immunosuppressed. Reports have shown an increased incidence of AFX in patients with AIDS and in patients who are immunosuppressed because of organ transplantation.

One case of localized cutaneous metastases has been reported after excision of the primary lesion. This is extremely rare.