From the Guidelines
The primary treatment for fibroxanthoma, specifically atypical fibroxanthoma (AFX), is surgical excision, which is usually curative, although local recurrence is common, with metastases occurring in less than 1% of cases 1. When considering treatment options, it's essential to note that AFX is a low-grade cutaneous spindle cell tumor that can be histologically indistinguishable from other spindle cell tumors.
- The goal of treatment is to achieve complete removal of the tumor with clear margins, which can be challenging, especially in areas where wide excision is not possible, such as the scalp.
- In such cases, adjuvant radiotherapy may be necessary, and the reconstructive procedure should be planned to tolerate postoperative radiotherapy 1.
- A preoperative core or punch biopsy is preferred over a diagnostic excision biopsy to secure the diagnosis, allowing for appropriate planning of the surgical approach and potential adjuvant treatments.
- The prognosis for AFX is generally good, with cure rates exceeding 90% when appropriate surgical margins are achieved, emphasizing the importance of early and accurate diagnosis, followed by prompt and effective treatment 1.
From the Research
Treatment for Fibroxanthoma
The treatment for fibroxanthoma, specifically atypical fibroxanthoma (AFX), typically involves surgical excision. The goal of treatment is to remove the tumor completely while minimizing surgical morbidity.
- Surgical Excision: Studies have shown that surgical resection with adequate margins is effective in treating AFX 2, 3. The size of the margin required may depend on the size of the tumor, with smaller tumors potentially requiring smaller margins 3.
- Mohs Micrographic Surgery (MMS): MMS is a surgical technique that involves removing the tumor layer by layer, examining each layer under a microscope until no cancer cells are found. This technique has been shown to be effective in treating AFX, with low recurrence rates 4, 5.
- Wide Local Excision (WLE): WLE involves removing the tumor with a margin of normal tissue around it. The size of the margin required may vary, but studies have suggested that a margin of 1-2 cm may be sufficient 3, 4.
- Recurrence Rates: Recurrence rates for AFX have been reported to be similar between MMS and WLE techniques, with pooled proportions of recurrence ranging from 6.6% to 11.3% 4. The time to recurrence has also been reported to be similar between the two techniques, with a pooled time to recurrence of 13.3-14.2 months 4.
Factors Influencing Treatment Outcomes
Several factors may influence treatment outcomes for AFX, including:
- Tumor size: Smaller tumors may require smaller margins, while larger tumors may require more extensive excision 3.
- Tumor depth: Tumors that extend beyond the dermis into the underlying adipose and muscular tissue may have a higher risk of local recurrence and metastasis 6.
- Patient demographics: AFX typically occurs in elderly Caucasian males, and treatment outcomes may vary depending on patient demographics 2, 6.