More Than 2 Decades of Treating Atypical Fibroxanthoma at Mayo Clinic: What Have We Learned From 91 Patients?


Address correspondence and reprint requests to: Randall K. Roenigk, MD, Department of Dermatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, or e-mail:


BACKGROUND Atypical fibroxanthoma (AFX) typically occurs on the head and neck of elderly white men. Usually considered a malignancy, it is treated with wide local excision (WLE) or total margin control using Mohs micrographic surgery (MMS).

OBJECTIVE To determine the most appropriate treatment for this tumor based on a review of cases treated at Mayo Clinic.

METHODS We reviewed the medical records of patients with AFX treated at Mayo Clinic from 1980 to 2004.

RESULTS We identified 91 patients with 93 tumors. Treatment information was available for 88 tumors (59 treated with MMS, 23 with WLE, and 6 by other means). There were no recurrences in the patients treated with MMS, with a median follow-up of 4.5 years (range 1.0–16.1 years). Two patients treated with WLE had single recurrences, with a median follow-up of 8.7 years (range 1.5–26.3 years).

CONCLUSIONS Total microscopic margin control using MMS was the most effective means of treating AFX.