Abstract
Atypical fibroxanthoma (AFX) and undifferentiated pleomorphic sarcoma (UPS) are spindle cell malignancies that present as red or pink nodules on the head or neck. Due to their similar clinical presentation with other nonmelanoma skin cancers, many clinicians perform a diagnostic shave biopsy, which can transect the tumor. While AFX tumors are rarely, UPS tumors can develop distant disease and thus are frequently sent to a surgical oncologist. As such, the dermatologist is left with a clinical conundrum: to which type of surgeon do you send a transected AFX/UPS to? While the diagnosis can be established with full tumor extirpation, a shave biopsy can transect the tumor, precluding evaluation of the aggressive growth pattern at its base.
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