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Authors: Helbig, Doris
Ziemer, Mirjana
Dippel, Edgar
Erdmann, Michael
Hillen, Uwe
Leiter, Ulrike
Mentzel, Thomas
Osterhoff, Georg
Ugurel, Selma
Utikal, Jochen
Bubnoff, Dagmar von
Weishaupt, Carsten
Grabbe, Stephan
Title: S1-guideline atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS)
Online publication date: 6-Sep-2022
Year of first publication: 2022
Language: english
Abstract: Atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS) are rare cutaneous neoplasms representing histomorphological, genetic as well as epigenetic variants of a disease spectrum. Both tumors typically manifest as nonspecific, often ulcerated, skin- to flesh-colored nodules in chronically sun-damaged skin of elderly male patients. AFX is a rather well demarcated, often rapidly growing tumor. PDS tumors are poorly circumscribed and are characterized by aggressive infiltrative growth. Fast as well as slow growth behavior has been reported for both tumors. Histologically, both are composed of spindle-shaped and epithelioid tumor cells with pleomorphic nuclei as well as atypical multinucleated giant cells. Atypical mitoses are common. In contrast to AFX, PDS involves relevant parts of the subcutis and shows areas of tumor necrosis and/or perineural infiltration. Due to the poorly differentiated nature of AFX/PDS (Grade 3), histopathologically similar cutaneous sarcomas, undifferentiated carcinomas, melanomas and other diseases have to be excluded by immunohistochemical analysis. The treatment of choice is micrographically controlled surgery. In cases of AFX, a cure can be assumed after complete excision. Local recurrence rates are low as long as PDS tumors are surgically removed with a safety margin of 2 cm. Metastasis is rare and mostly associated with very thick or incompletely excised tumors; it mainly affects the skin and lymph nodes. Distant metastasis is even more rare. No approved and effective systemic therapy has been established.
DDC: 610 Medizin
610 Medical sciences
Institution: Johannes Gutenberg-Universität Mainz
Department: FB 04 Medizin
Place: Mainz
Version: Published version
Publication type: Zeitschriftenaufsatz
License: CC BY-NC-ND
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Journal: Journal der Deutschen Dermatologischen Gesellschaft
Pages or article number: 235
Publisher: Wiley-Blackwell
Publisher place: Berlin
Issue date: 2022
ISSN: 1610-0387
Publisher DOI: 10.1111/ddg.14700
Appears in collections:DFG-491381577-H

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