Malignant Fibrous Histiocytoma

Malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma in adults, but involves the head and neck region in only 1 to 3 percent of cases.104-106 There is a 3:2 male to female predominance, and the majority of cases occur in patients 50 to 70 years of age. Subcutaneous lesions form only a small proportion of head and neck MFH, with the majority arising from the upper aerodigestive tract and deep tissues of the neck. Overall, MFH accounts for only 0.01 percent of cutaneous malignancies.104,106 Studies suggest that MFH in the subcutis has a more infiltrative growth pattern and higher rate of recurrence after surgical treatment. A study by Fanburg-Smith and colleagues showed that 83 percent of subcutaneous MFH displayed an infiltra-tive growth pattern in contrast to only 24 percent of intramuscular cases.107,108 Higher rates of involved margins occurred in cases displaying infiltrative growth, advocating a need for wide surgical margins. Local recurrences occurred exclusively in cases displaying infiltrative growth. Wide resection, with margins over 2 cm, is advocated for cutaneous MFH. Adjuvant radiation therapy should be considered in locally advanced cases.

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