Atypical fibroxanthomas generally present as rapidly growing nodular lesions in the sun-exposed areas of head and neck regions of older patients. Due to their rapid growth, they may be mistaken clinically for an aggressive lesion. The lesions are polypoid, usually without ulceration, and range in size from 1-6 cm. Microscopically, they are composed of atypical, pleomorphic cells in a spindled stroma. The anaplastic cells can be appreciated in this image even at low magnification. The overlying epidermis is uninvolved.