Atypical fibroxanthoma arising in a tracheostomy scar: A rare cicatricial neoplasm

Dear Editor, Atypical fibroxanthoma (AFX) is a cutaneous neoplasm that classically occurs in heavily sun‐damaged skin on the head and neck of elderly patients.1 We report the case of a 70‐year‐old man who presented with a 1‐year history of a slowly enlarging, nodular lesion on his anterior neck (Fig. 1). The lesion was asymptomatic, apart from scant straw‐yellow discharge that had emanated from the lesion since its onset. The lesion was at the site of a scar from a tracheostomy, which was performed 40 years earlier following a motor vehicle accident. On examination, a nontender, flesh‐coloured nodule was found at the superior aspect of the scar, with a central pit and serous crusting. The lesion was mobile with deglutition due to cicatricial tethering to the trachea. A punch biopsy revealed a pleomorphic tumour with immunohistochemistry consistent with AFX, and the excision specimen supported this diagnosis (Fig. 2a–c).