By Gary M. White, MD

Atypical fibroxanthoma--AFX
The atypical fibroxanthoma (here on the scalp) is often mistaken for a squamous cell carcinoma.

An atypical fibroxanthoma (AFX) is a cutaneous tumor which in many ways behaves like a squamous cell carcinoma (SCC). It most commonly occurs in an older person on the head and neck, presumably related to chronic sun exposure.


A solitary papule which grows to an ulcerated nodule on the head or neck in an older white person is characteristic. Bleeding and ulceration are common. Metastasis may rarely occur. Immunohistochemical studies are needed to exclude SCC and melanoma. In one study of 152 cases from a single institution [Am J Dermatopathol 2015;Jan 14 ahead of print], 11 cases metastasized (7.2%). Greater depth, necrosis, and vascular invasion negatively predicted behavior.


Mohs surgery is preferred.

Additional Pictures

The ear is a common location for an AFX.
Atypical fibroxanthoma--AFX of the ear Atypical fibroxanthoma--AFX of the ear

Atypical fibroxanthoma--AFX


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