Clinically, the lesions are usually suspected to be malignant because they arise rapidly, over just a few weeks or months, in skin where other skin cancers have been found and treated. When this clinical impression is combined with highly anaplastic pathology, misdiagnosis can lead to unneeded, extensive surgery and radiation. This lesion histologically shows a highly atypical and pleomorphic cellular appearance, but typically responds to simple excision.
Clinicopathologic correlation is essential.
Factors which are important to consider are lesion location, the patient's age, histopathologic appearance, and the observation that the tumor arises from the dermis, not the fat. Many AFX may represent a superficial form of malignant fibrous histiocytoma with a much better prognosis. Some cases may represent primarysquamous cell carcinoma that fails to express keratin. Gender distribution is equal. Radiation damage of the head, neck, and scalp.