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

Abstract

Background: 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.

Objective: This study evaluated recurrence, metastasis, and surgical outcomes of AFX treated with MMS versus WLE, with emphasis on immunosuppression as a prognostic factor.

Methods: 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. 

Results: 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). 

Conclusion: 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.