Atypical fibroxanthoma of the cheek in an elderly patient: a case report and literature review.

Atypical fibroxanthoma (AFX) is a rare fibroblastic cutaneous malignancy that predominantly arises in sun-exposed regions of the head and neck in elderly individuals. Accurate diagnosis of AFX remains challenging because of its rarity and histopathologic overlap with other spindle- cell tumors, especially when the initial biopsy findings are inconclusive. The authors encountered a 90-year-old woman who presented with a rapidly growing, ulcerative nodule on the left cheek. An initial biopsy performed at a local dermatology clinic showed spindle cell proliferation without a definitive diagnosis. A subsequent punch biopsy confirmed AFX. The patient showed no evidence of metastasis or lymphadenopathy in the preoperative examination. The tumor was treated with a wide local excision using a 1 cm safety margin, followed by a reconstruction with a full-thickness skin graft. At 1-year follow-up, the patient showed no evidence of local recurrence or metastasis, and the aesthetic outcome was satisfactory. This case highlights the diagnostic difficulty of AFX, particularly in elderly patients with nonspecific biopsy findings. Careful histopathologic evaluation, appropriate surgical management, and long-term follow-up are essential for optimal outcomes. Reporting well-documented cases like the present one may help improve the diagnostic accuracy and clinical management of this uncommon malignancy.