Outcomes of atypical fibroxanthoma treated with mohs surgery or wide local excision: A retrospective review.

Authors

Kevin Varghese, William Liakos, Atieh Jibbe

Published in

Dermatology online journal. Volume 32. Issue 2. May 08, 2026. Epub May 08, 2026.

Abstract

Atypical fibroxanthoma (AFX) is a rare cutaneous spindle cell neoplasm that typically affects elderly men on sun-exposed sites. Mohs micrographic surgery (MMS) and wide local excision (WLE) are common treatments, but comparative outcomes remain incompletely defined.
This study evaluated recurrence, metastasis, and surgical outcomes of AFX treated with MMS versus WLE, with emphasis on immunosuppression as a prognostic factor.
A retrospective review was performed of 23 patients with histologically confirmed AFX treated at a single academic center from 2010 to 2024. Demographic, clinical, and surgical variables were abstracted. Outcomes included local recurrence, metastasis, and defect size. Fisher exact and Mann-Whitney U tests were used for exploratory analysis.
Fourteen patients underwent MMS and 9 underwent WLE. Recurrence rates were similar between groups (14% versus 11%). However, all recurrences and the single metastasis occurred in immunosuppressed patients, who had a higher recurrence rate than immunocompetent patients (67% versus 5%; P = .10). Postoperative defect size was smaller with MMS than with WLE (3.1 cm versus 5.5 cm; P < .001).
MMS provided effective tumor clearance with tissue conservation. Immunosuppression was strongly associated with adverse outcomes, underscoring the need for close surveillance in this high-risk subgroup.

PMID:
42522486
Bibliographic data and abstract were imported from PubMed on 29 Jul 2026.

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