Among the many types of skin cancers, dermatofibroma is one of the least understood. It is a rare type of skin tumor, which can cause scarring on the skin. This article discusses its symptoms, diagnosis, and treatment options.
Diagnosis
Generally, the diagnosis of dermatofibroma can be made clinically. However, in cases where the lesions are difficult to distinguish from malignant fibrohistiocytic tumors, a biopsy may be required. This is particularly true for dermatofibromas with a prominent pigment network, which can make it difficult to differentiate from melanoma.
Dermatofibromas usually appear as firm, asymptomatic nodules that may range in size from a few millimeters to 2 cm. They usually develop in the lower limbs between the third and fifth decade of life. However, dermatofibromas have been reported to develop at any age. Dermatofibromas may also develop on other parts of the body, such as the face and trunk. However, dermatofibromas are most common on the arms and legs of women. In addition, dermatofibromas are associated with a number of conditions, such as pregnancy, lupus, and HIV. Dermatofibromas have also been linked with immunosuppression.
Dermatofibroma is characterized by a variable admixture of macrophages. It is also characterized by a proliferation of fibrous cells within the dermis. These cells have abundant eosinophilic cytoplasm and entrap sclerotic collagen bundles. They may be shiny and may also have areas of hemorrhage. Dermatofibroma may also be associated with civilization.
Dermatofibroma is a common noncancerous neoplasm, which occurs in approximately 3% of skin lesion specimens. It usually develops during mid-adult life. Dermatofibroma is usually confined to the dermis, but it can also invade the subcutaneous tissue. It can appear as a firm yellow or red nodule on the skin, with or without a margin.
The diagnosis of dermatofibroma is usually made clinically, and a histologic examination of the biopsy can confirm the diagnosis. However, in cases where the lesions appear in clusters, the presence of multiple dermatofibromas may be indicative of immune suppression. Serologic testing may also be recommended for patients with multiple dermatofibromas. Dermatofibroma may also be suspected in patients with epidermal cysts or panniculitis.
Dermatofibroma is associated with a low rate of local recurrence after excision. However, the prognosis for metastases is excellent. Dermatofibroma is usually cured with simple excision. A dermoscopy may be helpful in visualizing DF, as it can reveal a new dimension of clinical morphologic features in skin lesions. However, solitary dermatofibromas have minimal diagnostic value in imaging studies. They are also difficult to differentiate from other tumors.
Dermatofibroma is commonly associated with epidermal hyperplasia. The most common pattern under dermoscopy is a peripheral pigment network with a central white area. In a few cases, a dotted vascular pattern can be seen. In addition, dermatofibroma may show a “Storiform” pattern, which is characterized by whorls of elongated nuclei. It may also be difficult to differentiate dermatofibroma with giant cells from malignant fibrous histiocytoma. This may be because dermatofibroma with giant cells shares morphologic features with atypical fibroxanthoma.
Dermatofibromas have been studied in case series, including a low number of patients. However, additional multicenter prospective studies are needed to clarify morphological changes during the disease course.
Treatment options
Whether you have a dermatofibroma or you have never heard of this skin growth, you should know that it is a harmless, non-cancerous growth on the skin. These bumps are normally found on the lower legs, arms, and upper back. These growths are often seen in younger individuals, but can also be seen in older adults. Dermatofibromas are usually not painful but may be itchy or scaly. If you are concerned about your dermatofibroma, you can discuss your options with your doctor.
Dermatofibromas can be caused by an overgrowth of skin cells. In most cases, the skin growth is benign and does not need to be removed. However, if it is growing rapidly, becomes irritated, or looks unsightly, it may need to be removed. Dermatofibroma removal is a surgical procedure that can be performed by a doctor, and there are several different treatment options.
Dermatofibroma can be cured by cryosurgery, which involves freezing the skin lesion with liquid nitrogen. This procedure can be a short outpatient procedure. The surgery is usually performed using local anesthesia. However, the procedure can result in scarring. If the dermatofibroma is larger, it may require surgery that is more invasive. In these cases, your doctor may recommend surgical excision. The doctor may also use a dermatoscope to examine the growth. The doctor may pinch the surrounding skin to check for a dimple.
Some people choose to remove their dermatofibroma for cosmetic reasons. Dermatofibromas are usually benign, and removal is usually safe and effective. However, the growth may return after the removal. This is why you should always have the growth checked by a doctor, and if your growth is painful or scaly, you should consider having it removed.
If you have a dermatofibroma that is larger than a millimeter, you should also consider having it removed. Surgical removal may not be necessary, but it is a good idea to have the growth removed if it is causing you pain. Surgical removal may also remove any signs of cancer, but there is a chance cancer may recur. For this reason, your doctor may recommend imatinib, a medication that targets cancer cells that produce excess protein. Imatinib can destroy cancer cells and cause cancer to die. If cancer returns, your doctor may recommend continuing to take imatinib.
If you have a dermatofibroma on your legs, you should also consider taking extra precautions during the healing time. This is because the area is often very tender, and may become infected if a surgical procedure is performed on it. You may also have to be extra careful with any wounds that heal after surgery on the legs. If you do have a wound that heals poorly, your doctor may recommend a corticosteroid injection to help reduce the size of the dermatofibroma.
Recurrences
Despite its benign nature, dermatofibroma has been characterized by a high rate of local recurrence after excision. This is a clinically important feature and requires close clinical follow-up. Dermatofibroma can also metastasize to lymph nodes and internal organs. These metastatic occurrences are rare. The recurrence rates are largely determined by the cellular subtype of dermatofibroma. Cellular dermatofibroma is characterized by abundant eosinophilic cytoplasm and a storiform growth pattern. Cellular dermatofibroma tends to recur more frequently than benign dermatofibroma. Various morphological and chromosomal variations of dermatofibroma exist. The presence of chromosomal aberrations may be a marker of cellular dermatofibroma’s malignant potential.
A systematic review of 119 patients was conducted. This included cases with both clinically important and non-clinically important dermatofibromas. The patients were followed for a median of 83 months. The patients were evaluated for chromosomal aberrations, microscopic foci, and histopathological features. A cellular dermatofibroma was identified in nine cases and an atypical dermatofibroma in a further five. The neoplasms were found to have a variety of histological features, but the majority were confined to the dermal reticular dermis. In addition, the epidermis was preserved in seven cases.
The chromosomal profile showed gains on chromosomes 3 and 11 in one case, and gains on chromosomes 3 and 8 in another. Four of the seven cases had genomic aberrations on two or three chromosomes. However, the malignant transformation was not detected.
The majority of the cases had a storiform growth pattern and the infiltration of subcutis was seen in five cases. The majority of the cases were women. The neoplasms ranged in size from one to nine centimeters in diameter. The incidence of recurrence was high among cases with aneurysmal dermatofibroma. Aneurysmal dermatofibroma is characterized as a rapidly growing blue-brown nodule that lacks an endothelial lining. The neoplasms were composed of spindle cell fascicles and hyalinized collagen bundles. The neoplasm cells were largely monomorphic and slimmer than the cells in the primary tumor. They stained intensely for CD34.
Aneurysmal dermatofibroma can metastasize to lymph nodes and internal organs. This type is known to recur in up to one in five cases. It tends to occur on the trunk and limbs of young adults, but can also occur on the face. However, it is unclear whether this type of dermatofibroma can be differentiated from the benign type.
Cellular dermatofibromas tend to be associated with a higher rate of local recurrence after surgery, but the exact mechanism for this is unclear. The increased rate of recurrence may be due to increased mitotic activity or a more aggressive clinical course. The incidence of local recurrence is more likely with cellular dermatofibromas that are clinically important. In contrast, atypical dermatofibroma is associated with a relatively low rate of local recurrence after surgical excision. Atypical dermatofibromas tend to have more chromosomal aberrations, but the number of chromosomal aberrations does not necessarily reflect the biologic continuum from benign to malignant.
Health Sources:
Health A to Z. (n.d.). HSE.ie. https://www2.hse.ie/az/
U.S. National Library of Medicine. (n.d.). https://www.ncbi.nlm.nih.gov/
Directory Health Topics. (n.d.). https://www.healthline.com/directory/topics
Health A-Z. (2022, April 26). Verywell Health. https://www.verywellhealth.com/health-a-z-4014770
Harvard Health. (2015, November 17). Health A to Z. https://www.health.harvard.edu/health-a-to-z
Health Conditions A-Z Sitemap. (n.d.). EverydayHealth.com. https://www.everydayhealth.com/conditions/
