Clinical Spectrum of Atypical Fibroxanthoma and Undifferentiated Pleomorphic Sarcoma in Solid Organ Transplant Recipients: A Collective Experience

• Published in: Dermatologic surgery Vol. 38; no. 2; pp. 230 - 239
• Main Authors: McCoppin, Holly H., Christiansen, Daniel, Stasko, Thomas, Washington, Carl, Martinez, Juan Carlos, Brown, Marc D., Zwald, Fiona O.
• Format: Journal Article
• Language: English
• Published: Malden, MA by the American Society for Dermatologic Surgery, Inc. Published by Lippincott Williams & Wilkins 01.02.2012; Wiley
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Dermatology; Heart Transplantation - immunology; Histiocytoma, Benign Fibrous - etiology; Histiocytoma, Benign Fibrous - immunology; Histiocytoma, Benign Fibrous - secondary; Histiocytoma, Benign Fibrous - therapy; Histiocytoma, Malignant Fibrous - etiology; Histiocytoma, Malignant Fibrous - immunology; Histiocytoma, Malignant Fibrous - pathology; Histiocytoma, Malignant Fibrous - secondary; Humans; Immunosuppression - adverse effects; Kidney Transplantation - immunology; Liver Transplantation - immunology; Male; Medical sciences; Middle Aged; Neoplasm Recurrence, Local; Skin Neoplasms - etiology; Skin Neoplasms - immunology; Skin Neoplasms - pathology; Skin Neoplasms - therapy; Skin plastic surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Sarcoma; Dermatology; Transplantation; Malignant tumor; Homotransplantation; Symptomatology; Fibrous histiocytoma; Treatment; Surgery; Graft; Atypical; Benign neoplasm; Cancer; Organ
• ISSN: 1076-0512; 1524-4725
• DOI: 10.1111/j.1524-4725.2011.02180.x

Background Atypical fibroxanthoma (AFX) and undifferentiated pleomorphic sarcoma (UPS) are uncommon, spindle cell cutaneous malignancies. Solid organ transplant recipients (SOTRs) are immunosuppressed and therefore have a higher incidence of cutaneous malignancies. Objective We describe the clinical spectrum of AFX and a more‐aggressive, deeper variant, UPS, in SOTRs. Materials and Methods A retrospective chart review of AFX and UPS in SOTRs was implemented. Cases from Vanderbilt University, Emory University, Mayo Clinic—Jacksonville, and University of Rochester were included. A literature search included previously published cases. Results The average age of SOTRs at time of tumor presentation was younger than typically seen in immunocompetent patients for AFX. Rates of local recurrences and metastases were higher in the SOTRs than is noted in the immunocompetent literature. Rates of recurrence were higher in those treated with excision than in those treated with Mohs micrographic surgery (MMS). Conclusion AFX and UPS may have a greater risk for recurrence, metastases, and mortality in SOTRs, in whom early treatment with MMS may demonstrate certain advantages in terms of minimizing risk of recurrence and metastasis. UPS and recurrent tumors should be staged appropriately and may respond to adjuvant radiation therapy and reduction of immunosuppression. Immunohistochemical evaluation is recommended to exclude other spindle cell tumors.