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Progression of the atypical fibroxanthoma to pleomorphic dermal sarcoma in a heart transplant patient
  1. Valeria Ripa1,
  2. Natasha Singh2,
  3. Allen E Star1 and
  4. Franz Smith3
  1. 1General Surgery, Saint Barnabas Medical Center, Livingston, New Jersey, USA
  2. 2Pathology, Saint Barnabas Medical Center, Livingston, New Jersey, USA
  3. 3Surgery, Saint Barnabas Medical Center, Livingston, New Jersey, USA
  1. Correspondence to Dr Valeria Ripa; valeriaripa87{at}


An 82-year-old man presented with a right scalp lesion which had been increasing in size. The patient’s medical history was significant for a heart transplant 25 years before, and he was on chronic immunosuppression. Biopsy of the lesion showed atypical fibroxanthoma. The patient underwent an excision of the lesion with split thickness skin graft. Pathology showed fibroxanthoma with negative margins. Over the next 9 months, the patient developed new lesions, which were also excised to negative margins. However, with each new lesion, the histology demonstrated increasing dysplasia and ultimately pleomorphic sarcoma. The patient had a metastatic workup with CT of the chest, which was negative, and he underwent a radical scalpectomy, split thickness skin graft placement and adjuvant radiation therapy. The patient has not developed any new scalp lesions and no evidence of metastasis.

  • dermatology
  • skin cancer
  • surgical oncology
  • plastic and reconstructive surgery

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  • Contributors VR wrote the original manuscript and performed a literature review. NS provided pathology slides. AES performed a literature review. FS was involved in the patient’s care; provided digital material; revised and edited the manuscript; and gave the final approval for the manuscript submission. All authors approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.