Currently accepted at: JMIR Dermatology
Date Submitted: Sep 26, 2025
Open Peer Review Period: Oct 27, 2025 - Dec 22, 2025
Date Accepted: Feb 10, 2026
(closed for review but you can still tweet)
This paper has been accepted and is currently in production.
It will appear shortly on 10.2196/84550
The final accepted version (not copyedited yet) is in this tab.
A Woman With a Rapidly Enlarging Tender Papule
ABSTRACT
Background:
Atypical fibroxanthoma (AFX) is a rare mesenchymal neoplasm that is most commonly identified on sun-exposed areas of the head, neck, and dorsal extremities of elderly patients.
Objective:
To present a rare case of AFX, its clinical presentation, histopathology, treatment, and to discuss the use of immunohistochemistry as a method in diagnosing AFX.
Methods:
We evaluated a 67-year-old woman with a history of basal and squamous cell carcinomas who presented with a rapidly enlarging, tender papule on the dorsal left hand. Prior topical fluorouracil therapy was ineffective. Histopathologic examination confirmed the diagnosis, and treatment was initiated. A literature review was performed to place this case in context with other reported instances of AFX.
Results:
Clinical examination revealed a 1.2 cm dome-shaped, red-pink papule; shave biopsy demonstrated histopathologic features consistent with atypical fibroxanthoma (AFX). The patient was referred to Mohs micrographic surgery with a high cure rate, where the tumor was cleared in a single stage, with histologically negative margins.
Conclusions:
This case highlights the importance of clinicopathologic correlation, appropriate use of immunohistochemistry, and evidence-based surgical management in AFX.
Citation
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Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.