A COMPARISON OF MOHS MICROGRAPHIC SURGERY AND WIDE EXCISION FOR THE TREATMENT OF ATYPICAL FIBROXANTHOMA

BACKGROUND. Atypical fibroxanthoma (AFX) is an uncommon spindle cell n eoplasm occurring most often in actinically damaged skin of elderly pa tients. This tumor has invasive potential, may recur locally after exc ision, and rarely metastasizes. To conserve tissue and improve the lik elihood of cure, Mohs micrographic surgery (MMS) has been used for tre atment. OBJECTIVE. We review and discuss the Mayo Clinic experience tr eating AFX with MMS and retrospectively compare the clinical outcome w ith that in a similar cohort of patients treated with wide local excis ion (WE). METHODS. The medical records of 45 patients were reviewed at three Mayo Clinic practices. Follow-up data were available for 44 pat ients: 19 treated with MMS and 25 with WE. RESULTS. In patients treate d with MMS, there were no recurrences after a mean follow-up of 29.6 m onths. There were three first recurrences in 25 patients (12%) treated with WE after a mean follow-up of 73.6 months. One patient had a sing le local recurrence, and two patients each had two local recurrences. Parotid node metastasis eventually developed in one of the patients wi th two local recurrences, so that the regional metastatic rate in this series was 4% (1 in 25 patients). CONCLUSION. Microscopic control of the surgical margins with MMS in the treatment of AFX results in a low er recurrence rate than that with WE and conserves normal tissue. (C) 1997 by the American Society for Dermatologic Surgery, Inc.