Atypical Fibroxanthoma Presenting as a Rapidly Enlarging Tender Papule: Case Report.
4 affiliations
- 1Rocky Vista University, Ivins, UT, United States.
- 2Rocky Vista University, 8401 S Chambers Rd, Englewood, CO, United States, 1 3033732008.
- 3Advanced Dermatology and Cosmetic Surgery, Brandon, FL, United States.
- 4Advanced Dermatology and Cosmetic Surgery, Delray Beach, FL, United States.
Abstract
Background
Atypical fibroxanthoma (AFX) is a rare dermal mesenchymal neoplasm that is most commonly identified on sun-exposed areas of the head and neck of older adults. Presentation on the dorsal hand is uncommon.Objective
This report presents a rare case of AFX, its clinical presentation, histopathology, and treatment, and discusses the use of immunohistochemistry as a method in diagnosing AFX.Methods
We evaluated a 67-year-old woman with a history of basal cell and squamous cell carcinomas who presented with a rapidly enlarging, tender papule on the dorsal aspect of her left hand. Prior topical 5-fluorouracil therapy was ineffective. Histopathologic examination demonstrated findings favoring AFX, and treatment was initiated. A literature review was performed to contextualize this case among previously reported instances of AFX.Results
Clinical examination revealed a 1.2-cm, dome-shaped, erythematous papule. Histopathology demonstrated a dermal-based pleomorphic spindle cell neoplasm with brisk mitotic activity. Immunohistochemistry showed positivity for CD68 and CD10, with negative staining for SOX10, PRAME, pankeratin, p40, SMA, desmin, and CD34. The morphologic and immunohistochemical findings favored AFX. The tumor was completely excised via Mohs micrographic surgery (MMS) in a single stage with negative margins. No adjuvant therapy was required.Conclusions
AFX remains a diagnosis of exclusion requiring comprehensive immunohistochemistry to distinguish it from morphologic mimics with aggressive biologic behavior. This case highlights that MMS is the preferred treatment for AFX, offering the lowest recurrence rates with maximal tissue conservation.
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BibTeX
@article{tchernogorova2026atypical,
title = {{Atypical Fibroxanthoma Presenting as a Rapidly Enlarging Tender Papule: Case Report.}},
author = {Elizabeth Tchernogorova and Nicole Skalka and Mary Tidwell and Binh Minh Nguyen and Julien Lanoue and Robin Burger and McKenna Abercrombie},
journal = {JMIR dermatology},
year = {2026},
month = oct,
doi = {10.2196/84550},
url = {https://europepmc.org/article/MED/42961453},
note = {CC BY},
}
RIS
TY - JOUR
TI - Atypical Fibroxanthoma Presenting as a Rapidly Enlarging Tender Papule: Case Report.
AU - Elizabeth Tchernogorova
AU - Nicole Skalka
AU - Mary Tidwell
AU - Binh Minh Nguyen
AU - Julien Lanoue
AU - Robin Burger
AU - McKenna Abercrombie
PY - 2026
DA - 2026/10/30
JO - JMIR dermatology
DO - 10.2196/84550
UR - https://europepmc.org/article/MED/42961453
AB - Background Atypical fibroxanthoma (AFX) is a rare dermal mesenchymal neoplasm that is most commonly identified on sun-exposed areas of the head and neck of older adults. Presentation on the dorsal hand is uncommon.Objective This report presents a rare case of AFX, its clinical presentation, histopathology, and treatment, and discusses the use of immunohistochemistry as a method in diagnosing AFX.Methods We evaluated a 67-year-old woman with a history of basal cell and squamous cell carcinomas who presented with a rapidly enlarging, tender papule on the dorsal aspect of her left hand. Prior topical 5-fluorouracil therapy was ineffective. Histopathologic examination demonstrated findings favoring AFX, and treatment was initiated. A literature review was performed to contextualize this case among previously reported instances of AFX.Results Clinical examination revealed a 1.2-cm, dome-shaped, erythematous papule. Histopathology demonstrated a dermal-based pleomorphic spindle cell neoplasm with brisk mitotic activity. Immunohistochemistry showed positivity for CD68 and CD10, with negative staining for SOX10, PRAME, pankeratin, p40, SMA, desmin, and CD34. The morphologic and immunohistochemical findings favored AFX. The tumor was completely excised via Mohs micrographic surgery (MMS) in a single stage with negative margins. No adjuvant therapy was required.Conclusions AFX remains a diagnosis of exclusion requiring comprehensive immunohistochemistry to distinguish it from morphologic mimics with aggressive biologic behavior. This case highlights that MMS is the preferred treatment for AFX, offering the lowest recurrence rates with maximal tissue conservation.
SN - 2562-0959
ER -