Atypical Fibroxanthoma: Systematic Review and Meta-analysis of Treatment with Mohs Micrographic Surgery or Excision

Publication date: Available online 5 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Stanislav N. Tolkachjov, Benjamin F. Kelley, Fares Alahdab, Patricia J. Erwin, Jerry D. Brewer

Abstract

Background

Atypical fibroxanthoma (AFX) is a fibrohistiocytic tumor with relatively high local recurrence rates, but low metastatic potential. Wide local excision (WLE) and Mohs micrographic surgery (MMS) are common treatments, although no consensus exists regarding optimal therapy.

Objective

To systematically review evidence of AFX recurrence and metastatic rates following different surgical modalities.

Methods

Data Sources: Comprehensive search from 1946 or database inception to March 20, 2017.

Study Selection

Included studies had 5 or more patients with atypical fibroxanthoma treated surgically.

Data Extraction and Synthesis

Two reviewers independently abstracted the data. Risk of bias was assessed with Newcastle-Ottawa Scale.

Main Outcomes and Measures

Recurrence and metastasis.

Results

23 studies were selected (907 patients and 914tumors). 175 cases were treated with MMS (recurrence rate, 2.0% [95% CI, 0%-4.1%]; metastatic rate, 1.9% [95% CI, 0.1%-3.8%]). 732 were treated with WLE (recurrence rate, 8.7% [95% CI,5%-12.3%]; metastasis rate, 1% [95% CI, 0.2%-1.9%]). Among immunocompromised patients, no recurrence or metastases developed in the MMS subgroup, whereas 4/10 recurred and 1/10 metastasized in the WLE subgroup.

Limitations

low quality of published studies

Conclusion

MMS for atypical fibroxanthoma is associated with a lower recurrence rate than wide local excision.