Retrospective Analysis of the Recurrence of Atypical Fibroxanthoma When Treated With Curettage and Cautery at a Single Centre

Atypical fibroxanthoma (AFX) is a rare spindle cell neoplasm that arises within the dermis of chronically sun-exposed skin. Although wide local excision is standard practice, patients are regularly elderly and highly comorbid and therefore, curettage may offer a suitable alternative as a same day treatment with minimal aftercare. A retrospective case series was conducted analysing the files of all patients diagnosed with histopathological AFX at a single dermatology practice in Fremantle, Western Australia between the years 2016 and 2025. Kaplan-Meier analyses estimated recurrence rate with subgroup analyses comparing recurrence with gender, lesion location and lesion size. The study analysed 77 cases of AFX tumours treated with curettage and cautery. Patients had a mean age of 78.3 years with male predominance in the sample population. A total of nine tumours had documented recurrence, within a median time of 6.41 months, reflecting a crude recurrence rate of 11.69% and a Kaplan-Meier estimated 5-year recurrence rate of 16.99%. There were no disease-specific deaths, and no cases developed metastases. Given the high efficacy of curettage and cautery reflected in the study, and the lacking risk of disease-specific deaths and metastasis, a valuable treatment option is proposed. Employing curettage and cautery for AFX may reduce the personal and economic burden of cumbersome interventions, mitigating hospital admission and extensive wound care. Curettage and cautery may be of particular benefit in the nursing home population.