Dermal granulomatous inflammation was identified immediately adjacent to seven (77%) of nine atypical fibroxanthomas arising in sun damaged skin. Concomitant elastophagocytosis was observed in five (56%) of these seven patients. Similar inflammation with elastophagocytosis was found in association with only two (6%) of 36 epithelial tumours arising on the same background (10 basal and 10 squamous cell carcinomas, 10 nodular malignant melanomas, and six keratocanthomas). Granulomatous inflammation is an unusual dermal reaction to tumour and elastophagocytosis is rare. The fact that both of these features occur with inordinate frequency in association with atypical fibroxanthomas, when compared with other, more common skin tumours, suggests that atypical fibroxanthomas might modulate the inflammatory response, either passively, by its dermal location, or actively, by secreting locally effective cytokines.
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