The following is a summary of “Surgical excision margins for fibrohistiocytic tumors, including atypical fibroxanthoma and undifferentiated pleomorphic sarcoma: A probability model based on a systematic review,” published in the October 2022 issue of the Dermatology by Jibbe, et al.


The preferred course of therapy for fibrohistiocytic tumors with the potential to metastasize included large local excision or Mohs micrographic surgery, including atypical fibroxanthoma (AFX) and cutaneous undifferentiated pleomorphic sarcoma (cUPS). Since margin clearance is the best indicator of clinical recurrence, better guidelines for suitable surgical margins might help define consistent excision margins when intraoperative margin evaluation is impossible. For a study, researchers sought to establish suitable surgical broad local excision margins for AFX and cUPS.

To find case-level data, they searched the literature in Ovid MEDLINE, Embase, Web of Science, and the Cochrane Library between the beginning and March 2020. A mathematical model based on isolated, non-recurring examples was needed to estimate the margins.

The peripheral clearing margin (i.e., wide local excision margin) determined to clear 95% of all tumors was 2 cm for AFX and 3 cm for cUPS, according to probabilistic modeling based on 100 cases retrieved from 37 research. A 1 cm margin was necessary for AFX 1 cm or smaller tumors.

Atypical fibroxanthoma was less likely to return when excised with at least a 2 cm peripheral excision margin. Treatment options for smaller tumors, those measuring 1 cm or less, might be more cautious. To accomplish thorough removal while reducing surgical morbidity, margin-control surgical procedures were advised.

Reference: jaad.org/article/S0190-9622(21)02519-6/fulltext