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Background: Prognostication of atypical spindle cell neoplasms, including atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS), is challenging; outcomes vary widely, and further identification of prognostic features is crucial.

Objective: To evaluate prognostic factors that may portend worse outcomes in patients with AFX and PDS.

Materials And Methods: A retrospective chart review of patients with AFX and PDS was conducted.

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A rapidly-growing friable nodule on the cheek.

Dermatol Online J

August 2024

Department of Dermatology, Stanford University School of Medicine, California, USA Department of Dermatology, The Permanente Medical Group, Sacramento, California, USA.

Atypical fibroxanthoma and pleomorphic dermal sarcoma are on a spectrum of cutaneous tumors that present as ulcerated lesions in older adults. We present an 84-year-old man with pleomorphic dermal sarcoma, initially presenting as a bleeding lesion of the cheek that progressed to an eroded nodule.

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Undifferentiated pleomorphic sarcoma (UPS) and related tumors are the most common type of soft tissue sarcoma. However, this spectrum of tumors has different etiologies with varying rates of metastasis and survival. Two dermal-based neoplasms in this class of pleomorphic sarcomas, atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS), are challenging to differentiate at initial biopsy but vary significantly in prognosis.

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We report the case of a Hispanic male whose conjunctival atypical fibroxanthoma (AFX) grew very large, with intraocular as well as extraocular muscle extensions, and was treated with exenteration. A 50-year-old male presented with a one-month history of foreign-body sensation in his left eye. The initial examination revealed an erythematous, vascularized, pedunculated lesion arising from the left eye conjunctiva.

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