Dermatofibroma in Adult
Alerts and Notices
Synopsis
DFs are often solitary, though any individual may have more than one. Rarely, multiple eruptive dermatofibromas (MEDFs) may be seen. MEDF is arbitrarily defined as the presence of 5 to 15 or more DFs developing in less than a 4-month period. MEDF has been reported to occur in individuals with HIV infection; autoimmune disease, most frequently systemic lupus erythematosus; neoplastic disease; and in pregnant individuals. Multiple clustered dermatofibroma (MCDF) is a rare entity that develops in the first to third decades, where 15 or more DFs cluster together to form a plaque, most often on the lower half of the body.
In rare families with dominantly inherited DF, missense mutation in the factor XIII A-subunit has been detected.
Some rare variants of DFs, particularly aneurysmal, cellular, and atypical fibrous histiocytomas, are characterized by an increased risk of local recurrence compared to conventional DFs:
- Aneurysmal DF (hemorrhagic or hemosiderotic DF): This variant represents less than 2% of DFs. It mainly arises in young adults and shows rapid growth. Lesions tend to be larger than typical DFs, with a cystic consistency and a pigmented or vascular appearance. The rate of recurrence is about 20% following excision.
- Cellular DF: This variant represents less than 5% of cutaneous fibrous histiocytomas. Although more common in the extremities, it can sometimes occur on the face, ears, hands, and feet. In comparison to common DFs, cellular DFs are larger in size with a predilection for men and a higher recurrence rate of up to 26% in some studies.
- Atypical DF (DF with monster cells): This variant is usually seen in middle-aged adults. Lesions are slightly larger than 1 cm in diameter and are clinically similar to common DFs.
Codes
ICD10CM:D23.9 – Other benign neoplasm of skin, unspecified
SNOMEDCT:
427186000 – Dermatofibroma
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Melanocytic nevus
- Blue nevus
- Dysplastic nevus
- Dermatomyofibroma
- Keloid or hypertrophic scar (see scar)
- Prurigo nodularis
- Dermatofibrosarcoma protuberans (DFSP) is a locally invasive malignant neoplasm that can begin as a DF-size lesion. DFSP favors the trunk and progressively increases in size, while DFs do not substantially increase in size and favor the extremities.
- Spitz nevus
- Amelanotic or melanotic melanoma
- Atypical fibroxanthoma
- Neurilemmoma (schwannoma)
- Foreign body granuloma
- Pilomatricoma
- Supernumerary nipple
- Lichenoid keratosis
- Basal cell carcinoma
- Inflamed seborrheic keratosis
- Squamous cell carcinoma
- Multinucleated cell angiohistiocytoma
Best Tests
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Management Pearls
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Therapy
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References
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Last Reviewed:01/26/2022
Last Updated:02/15/2022
Last Updated:02/15/2022
Patient Information for Dermatofibroma in Adult
Overview
Dermatofibromas, or fibrous histiocytomas, are common skin growths. They are papules (small smooth, solid bumps) or nodules (larger smooth, solid bumps) that are firm or hard to the touch. They can be reddish, pink, brown, or skin-colored, and they may have a white scar-like center. Dermatofibromas are usually not painful or itchy, but occasionally they may be tender to the touch. They usually persist for life, but they may become flatter and softer after several years. When large numbers of dermatofibromas are present, there may be an underlying condition present, such as lupus or a weakened immune system, such as from leukemia or HIV.Who’s At Risk
Dermatofibromas may occur at any age but are seen more commonly in adults, particularly women.Signs & Symptoms
Dermatofibromas are most often found on the arms and legs of women. They are papules or nodules that may be tan, pink, red, or brown in lighter skin colors or any shade of brown in darker skin colors. They may have a whitish center. They feel quite firm or even hard, and sometimes they may be tender when touched. Many dermatofibromas demonstrate a "dimple sign," where the central portion puckers as the lesion is compressed on the sides. They generally do not change in size over the years, but older dermatofibromas may be flat or soft.Self-Care Guidelines
No self-care is necessary.When to Seek Medical Care
Seek medical evaluation for any new firm growth of any color on your skin.Treatments
Your medical professional may simply reassure you that what you have is a dermatofibroma and that no treatment is necessary. If your dermatofibroma is painful or cosmetically bothersome, they may try:- Liquid nitrogen (freezing) therapy to reduce the lesion's size. In darker skin colors, freezing with liquid nitrogen may cause skin color changes that may last for a long time.
- Surgical excision can be performed, but this will leave a linear scar that may be longer than the size of the original dermatofibroma.
Dermatofibroma in Adult