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Keloidal atypical fibroxanthoma of the scalp
  1. Kathryn McClelland1,
  2. Aidan Brady1,
  3. Paula Reid1 and
  4. Joe Houghton2
  1. 1Department of Cellular Pathology, Southern Health and Social Care Trust, Portadown, UK
  2. 2Institute of Pathology, Belfast Trust, Belfast, UK
  1. Correspondence to Dr Joe Houghton; joseph.houghton{at}


Atypical fibroxanthoma (AFX) is a rare low-grade sarcoma that occurs mainly in the elderly and may recur locally. There are multiple variants including keloidal AFX (KAF). KAF is characterised by a proliferation of atypical spindled and epithelioid cells admixed with bizarre pleomorphic cells. These cells intersect among broad bands of keloidal collagen. AFX is a diagnosis of exclusion so a broad panel of immunohistochemical staining should be applied to rule out other differentials (squamous cell carcinoma (SCC), melanoma, leiomyosarcoma, etc). There is added difficulty with the diagnosis of KAF as it may mimic multiple keloidal lesions, including exuberant scarring, as in this case. p53 immunohistochemistry staining can be useful in highlighting the presence of tumour cells. Additionally, next generation sequencing can detect genetic mutations identified in clonal proliferations consistent with tumour formation. KAF is easily overlooked and it should be included in the differential diagnosis for keloidal lesions showing even mild atypia.

  • Pathology
  • Dermatology
  • Skin cancer

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  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation of results, drawing original diagrams and algorithms and critical revision for important intellectual content: KM, AB, PR and JH. The following authors gave final approval of the manuscript: KM, AB, PR and JH.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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