Is Mohs Surgery the Best Option for Treating Atypical Fibroxanthoma?

Atypical fibroxanthoma (AFX) is a rare type of skin cancer that typically develops in sun-exposed areas of the body in older adults.

While not as common as basal cell carcinoma or squamous cell carcinoma, AFX can be concerning due to its invasive growth pattern in the skin.

In this article, we’ll explore why Mohs surgery has become the treatment of choice for AFX and discuss key considerations for patients around this specialized surgical technique.

Protect your skin: Learn about preventive measures against AFX and the role of Mohs surgery in treatment at Dermatology & Skin Health.

What Is Mohs Micrographic Surgery and Why Is It Used for AFX?

Mohs micrographic surgery, also known as Mohs surgery, is an advanced surgical method that involves progressively removing layers of skin cancer tissue, examining each layer under a microscope, and repeating the process until no cancer cells remain.

This meticulous process allows the removal of the entire tumor while preserving healthy tissue around it.

For AFX, Mohs surgery provides the highest cure rates compared to other treatment approaches. The precision involved ensures no roots or extensions of the tumor are left behind, which is critical given AFX's invasive growth pattern.

Mohs has become the gold standard treatment for AFX, significantly reducing recurrence rates.

What Is Atypical Fibroxanthoma?

Atypical fibroxanthoma is linked to exposure to radiation, including ultraviolet radiation from the sun and x-ray radiation. Significant skin damage caused by sun exposure and/or therapeutic radiation is connected to the development of atypical fibroxanthoma. This condition usually occurs on the head and neck of older individuals with sun-damaged skin, primarily in older men.

What Does AFX Typically Look Like and How Is It Diagnosed?

AFX most often appears as a reddish nodule or bump on sun-damaged skin, especially the head, neck, hands, or arms. The nodules can ulcerate and scab over, ranging in size from a few millimeters to a few centimeters across.

To definitively diagnose AFX, a biopsy is performed to examine cells under the microscope.

AFX has some similarities to squamous cell carcinoma under the microscope but shows distinct differences that help pathologists confirm the diagnosis.

Once diagnosed, Mohs surgery is typically recommended as the best option to remove the cancerous lesion and minimize recurrence risk.

Key Characteristics of Atypical Fibroxanthoma: Understanding the Signs and Risk Factors

Atypical Fibroxanthoma (AFX) primarily presents through distinct signs that can be observed in elderly individuals, especially on sun-damaged skin. Here's an improved description of its main signs:

1. Distinct Appearance of the Growth: AFX typically manifests as a single, red, or skin-colored nodule, predominantly seen on the head or neck areas of older adults. This growth may exhibit signs of bleeding or weeping, drawing attention to its potential malignancy.
2. Sun-Damaged Skin Predilection: The emergence of AFX is closely associated with skin that has sustained significant sun damage. This is most commonly observed in the head or neck regions, areas frequently exposed to sunlight, thereby emphasizing the importance of sun protection in these zones.
3. Higher Prevalence in Elderly Men: Statistical data indicates that elderly men are more susceptible to developing AFX compared to elderly women. This gender disparity highlights the need for increased awareness and regular skin checks, particularly in this demographic group.
4. Growth Size and Histopathological Characteristics: While the size of AFX growths typically does not exceed 2 cm in diameter, their small size belies their potential complexity. Histopathological examination often reveals critical features such as a high mitotic count, necrosis, ulceration, and vascular invasion, which are essential for accurate diagnosis and effective treatment planning.

Step-By-Step: What to Expect During Mohs Surgery for AFX

The Mohs surgery process consists of several intricate steps:

First, the visible AFX tumor is removed using a scalpel. The surgeon then maps and divides this tissue sample into sections to meticulously examine it under a microscope.

If cancer cells are seen at the edges, their location is mapped, and the process repeats only on that specific region of skin to precisely remove additional tissue. This continues layer-by-layer until the margins are clear.

Throughout the procedure, only local anesthesia is used, and patients remain awake so the surgeon can continually ensure critical structures like nerves or blood vessels are avoided. Patients may experience temporary pain or numbness around the surgery site.

Mohs surgery for AFX is typically done as an outpatient procedure. The entire process takes 1-2 hours on average, depending on the tumor size and location. Mohs surgeons must receive highly specialized training to correctly interpret tissue samples and achieve high precision.

Protect your skin: Learn about preventive measures against AFX and the role of Mohs surgery in treatment at Dermatology & Skin Health.

What Are the Outcomes After Undergoing Mohs Surgery for AFX?

With Mohs surgery, cure rates for AFX generally exceed 95% after a single procedure and 97-99% after a second re-excision if needed. This makes it significantly more effective than other treatment approaches.

Potential complications include temporary pain, bruising, swelling, and numbness that typically resolve within weeks as the wound heals.

Scarring may occur, but is often minimal with experienced surgeons. Serious risks like infection or bleeding are rare when proper surgical techniques are used.

Long-term, patients treated with Mohs surgery for AFX have an extremely low risk of recurrence. However, some follow-up exams may be recommended to monitor the skin and watch for any new lesions, especially in highly sun-damaged areas.

Overall, Mohs provides very high cure rates and optimal outcomes for AFX.

How Can Patients Prevent AFX and Care for the Skin After Mohs Surgery?

While not always preventable, ultraviolet sun exposure is a major risk factor for AFX.

Patients should take protective measures like sunscreen, wearing protective clothing, and avoiding excessive sun exposure. Self-skin exams and professional check-ups can help detect AFX early when treatment is most effective.

After Mohs surgery, proper wound care is vital, including keeping the area dry and clean while healing occurs over 7-14 days on average. Your surgeon will provide specific instructions on caring for the wound site and watching for any signs of complications.

Avoiding sun exposure and using sunscreen on the area is highly recommended long-term once healed.

Approximately 1-2% of skin cancers may recur after Mohs micrographic surgery, so patients should maintain regular skin self-exams and follow-ups with their dermatologist.

Have Advancements in Mohs Surgery Impacted AFX Treatment?

Some recent advancements may improve AFX treatment with Mohs surgery. Advanced imaging techniques help surgeons better visualize tumor margins.

New highly-precise computer-assisted tools can aid in tissue removal. And specialized pathology techniques allow more refined examination of tissue samples.

However, the core concepts of Mohs surgery remain critical. The emphasis is still on a methodical layer-by-layer approach and microscopic margin analysis by an expert. In the right dermatologic hands, Mohs remains unparalleled in its precision and effectiveness for eradicating AFX.

Final Thoughts: Why Mohs Surgery Remains Vital for Treating AFX

Mohs micrographic surgery has rightfully become the gold standard treatment for atypical fibroxanthoma, a potentially invasive skin cancer.

While specialized and complex, Mohs offers the highest cure and lowest recurrence rates compared to other therapies. Its precision and conservative approach make it ideal for removing AFX tumors while maximally preserving healthy tissue.

With proper training and experience, dermatologic surgeons can achieve excellent results with Mohs for AFX. While advancements may further refine the technique, Mohs remains arguably the most significant advancement in the surgical treatment of skin cancers like AFX over the past 70 years.

Its stepwise precision and microscopy make Mohs vital for optimal AFX outcomes.

Seeking expert care for AFX? Discover how Mohs surgery can help at Dermatology & Skin Health.