Dermatofibroma physical examination: Difference between revisions

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{{Dermatofibroma}}
{{Dermatofibroma}}
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{{SI}}
{{CMG}};{{AE}}{{Homa}} {{KS}}
{{CMG}};{{AE}}{{Homa}} {{KS}}


==Overview==
==Overview==
 
[[Physical examination]] of [[patients]] with dermatofibroma is usually shows a non-tender, [[Pigment|hyperpigmented]] [[Nodule (medicine)|nodule]] with 0.3 to 1 [[Centimetre|cm]] in [[diameter]] which dimple sign may be positive. It can seen in any part of the [[body]] but [[extremities]], especially [[legs]] are most common sites.
Dermatofibromas can be found anywhere on the body, but most often they are found on the legs and arms.
 
==Physical Examination==
 
Dermatofibromas can be found anywhere on the body, but most often they are found on the legs and arms. A dermatofibroma is associated with the dimple sign; by applying lateral pressure, there is a central depression of the dermatofibroma.
===Skin===
====Dermatofibroma====
 
<gallery widths=200px>
 
D1422.jpg | Dermatofibroma <br> [http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=99 <font size="-2">''Adapted from Dermatology Atlas''</font>]
D1423.jpg | Dermatofibroma <br> [http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=99 <font size="-2">''Adapted from Dermatology Atlas''</font>]
D1424.jpg | Dermatofibroma <br> [http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=99 <font size="-2">''Adapted from Dermatology Atlas''</font>]
D1425.jpg | Dermatofibroma <br> [http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=99 <font size="-2">''Adapted from Dermatology Atlas''</font>]
D1426.jpg | Dermatofibroma <br> [http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=99 <font size="-2">''Adapted from Dermatology Atlas''</font>]
D1428.jpg | Dermatofibroma <br> [http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=99 <font size="-2">''Adapted from Dermatology Atlas''</font>]
 
 
</gallery>
 
====Atrofic Dermatofibroma====
=====Trunk=====
<gallery>
Image:Atrofic Dermatofibroma01.jpg|Atrofic Dermatofibroma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
Image:Atrofic Dermatofibroma02.jpg|Atrofic Dermatofibroma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
Image:Atrofic Dermatofibroma03.jpg|Atrofic Dermatofibroma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
Image:Atrofic Dermatofibroma04.jpg|Atrofic Dermatofibroma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
Image:Atrofic Dermatofibroma05.jpg|Atrofic Dermatofibroma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
 
</gallery>
 
=====Extremities=====
<gallery>
Image:Atrofic Dermatofibroma06.jpg|Atrofic Dermatofibroma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
Image:Atrofic Dermatofibroma07.jpg|Atrofic Dermatofibroma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
Image:Atrofic Dermatofibroma08.jpg|Atrofic Dermatofibroma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
Image:Atrofic Dermatofibroma09.jpg|Atrofic Dermatofibroma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
Image:Atrofic Dermatofibroma10.jpg|Atrofic Dermatofibroma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
Image:Atrofic Dermatofibroma11.jpg|Atrofic Dermatofibroma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
 
</gallery>
 
===Extremities===
* Hard [[papule]]s (rounded bumps) that may appear in a variety of colors, usually brownish to tan.
** Especially found on the legs.
 
==Overview==
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
 
OR
 
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


==Physical Examination==
==Physical Examination==
Physical examination of patients with [disease name] is usually normal.
[[Physical examination]] of [[patients]] with dermatofibroma is usually shows a non-tender, [[Pigment|hyperpigmented]] [[Nodule (medicine)|nodule]] with 0.3 to 1 [[Centimetre|cm]] in [[diameter]] which dimple sign may be positive. It can seen in any part of the [[body]] but [[extremities]], especially [[legs]] are most common sites. 
 
OR
 
Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
 
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].
 
===Vital Signs===
 
*High-grade / low-grade fever
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]


===Skin===
===Skin===
* Skin examination of patients with [disease name] is usually normal.
*[[Skin]] [[examination]] of [[patients]] with dermatofibroma may show:<ref name="LeeLee2015">{{cite journal|last1=Lee|first1=MiWoo|last2=Lee|first2=WooJin|last3=Jung|first3=JoonMin|last4=Won|first4=ChongHyun|last5=Chang|first5=SungEun|last6=Choi|first6=JeeHo|last7=Moon|first7=KeeChan|title=Clinical and histological patterns of dermatofibroma without gross skin surface change: A comparative study with conventional dermatofibroma|journal=Indian Journal of Dermatology, Venereology, and Leprology|volume=81|issue=3|year=2015|pages=263|issn=0378-6323|doi=10.4103/0378-6323.154795}}</ref><ref name="MentzelWiesner2012">{{cite journal|last1=Mentzel|first1=Thomas|last2=Wiesner|first2=Thomas|last3=Cerroni|first3=Lorenzo|last4=Hantschke|first4=Markus|last5=Kutzner|first5=Heinz|last6=Rütten|first6=Arno|last7=Häberle|first7=Michael|last8=Bisceglia|first8=Michele|last9=Chibon|first9=Frederic|last10=Coindre|first10=Jean-Michel|title=Malignant dermatofibroma: clinicopathological, immunohistochemical, and molecular analysis of seven cases|journal=Modern Pathology|volume=26|issue=2|year=2012|pages=256–267|issn=0893-3952|doi=10.1038/modpathol.2012.157}}</ref><ref name="FitzpatrickGilchrest1977">{{cite journal|last1=Fitzpatrick|first1=Thomas B.|last2=Gilchrest|first2=Barbara A.|title=Dimple Sign to Differentiate Benign from Malignant Pigmented Cutaneous Lesions|journal=New England Journal of Medicine|volume=296|issue=26|year=1977|pages=1518–1518|issn=0028-4793|doi=10.1056/NEJM197706302962610}}</ref><ref>{{Cite journal
OR
| author = [[Marc Pusztaszeri]], [[Pierre-Yves Jaquet]] & [[Carole Williamson]]
*[[Cyanosis]]  
| title = Giant hemosiderotic dermatofibroma: a case report and review of the literature
*[[Jaundice]]
| journal = [[Case reports in dermatology]]
* [[Pallor]]
| volume = 3
* Bruises
| issue = 1
 
| pages = 32–36
<gallery widths="150px">
| year = 2011
 
| month =
UploadedImage-01.jpg | Description {{dermref}}
| doi = 10.1159/000324721
UploadedImage-02.jpg | Description {{dermref}}
| pmid = 21487458
 
|url=|first=|date=|via=}}</ref><ref>{{Cite journal
</gallery>
| author = [[L. Requena]], [[M. C. Farina]], [[C. Fuente]], [[E. Pique]], [[M. Olivares]], [[L. Martin]] & [[E. Sanchez Yus]]
 
| title = Giant dermatofibroma. A little-known clinical variant of dermatofibroma
===HEENT===
| journal = [[Journal of the American Academy of Dermatology]]
* HEENT examination of patients with [disease name] is usually normal.
| volume = 30
OR
| issue = 5 Pt 1
* Abnormalities of the head/hair may include ___
| pages = 714–718
* Evidence of trauma
| year = 1994
* Icteric sclera
| month =  
* [[Nystagmus]]
| pmid = 8176009
* Extra-ocular movements may be abnormal
|url=|first=|date=|via=}}</ref>
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
**[[Nodule (medicine)|Nodule]] with 0.3 to 1 [[Centimetre|cm]] in [[diameter]]
*Ophthalmoscopic exam may be abnormal with findings of ___
***'''Note''' : Giant (> 5 [[Centimetre|cm]]) are also reported.
* Hearing acuity may be reduced
** Non-tender [[nodule]]
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
***'''Note''': Manipulation can cause [[tenderness]].
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
**[[Hyperpigmentation]]
* [[Exudate]] from the ear canal
**[[Dimple]] [[Medical sign|sign]] ([[lateral]] compression on the [[skin]] makes a depression)
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
***'''Note''': [[Dimple]] [[Medical sign|sign]] can also seen in other [[skin changes]].
*Inflamed nares / congested nares
** Puritic [[Nodule (medicine)|nodule]] (may happen by [[superinfection]])
* [[Purulent]] exudate from the nares
[[File:Dimple sign.jpg|350px|thumb|https://www.dermnetnz.org/topics/dermatofibroma-images/|center]]
* Facial tenderness
[[File:Hyperpigmentation in dermatofibroma.jpg|350px|thumb|https://www.dermnetnz.org/topics/dermatofibroma-images/|center]]
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
 
===Neck===
* Neck examination of patients with [disease name] is usually normal.
OR
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]
 
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
OR
* Asymmetric chest expansion OR decreased chest expansion
*Lungs are hyporesonant OR hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds OR distant breath sounds
*Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]
 
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
OR
*Chest tenderness upon palpation
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the stethoscope
 
===Abdomen===
* Abdominal examination of patients with [disease name] is usually normal.
OR
*[[Abdominal distension]]  
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
 
===Back===
* Back examination of patients with [disease name] is usually normal.
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump
 
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge
 
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
OR
*Patient is usually oriented to persons, place, and time
* Altered mental status
* Glasgow coma scale is ___ / 15
* Clonus may be present
* Hyperreflexia / hyporeflexia / areflexia
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)


===Extremities===
===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
*[[Extremities]] are the most common site of dermatofibromas, especially [[Leg|legs]].<ref name="ŞenelYuyucu Karabulut2015">{{cite journal|last1=Şenel|first1=E.|last2=Yuyucu Karabulut|first2=Y.|last3=Doğruer Şenel|first3=S.|title=Clinical, histopathological, dermatoscopic and digital microscopic features of dermatofibroma: a retrospective analysis of 200 lesions|journal=Journal of the European Academy of Dermatology and Venereology|volume=29|issue=10|year=2015|pages=1958–1966|issn=09269959|doi=10.1111/jdv.13092}}</ref><ref name="HanChang2011">{{cite journal|last1=Han|first1=Tae Young|last2=Chang|first2=Hee Sun|last3=Lee|first3=June Hyun Kyung|last4=Lee|first4=Won-Mi|last5=Son|first5=Sook-Ja|title=A Clinical and Histopathological Study of 122 Cases of Dermatofibroma (Benign Fibrous Histiocytoma)|journal=Annals of Dermatology|volume=23|issue=2|year=2011|pages=185|issn=1013-9087|doi=10.5021/ad.2011.23.2.185}}</ref>
OR
*[[Clubbing]]  
*[[Cyanosis]]  
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity
 


==References==
==References==
{{reflist|2}}
{{reflist|2}}


 
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Latest revision as of 21:18, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Homa Najafi, M.D.[2] Kiran Singh, M.D. [3]

Overview

Physical examination of patients with dermatofibroma is usually shows a non-tender, hyperpigmented nodule with 0.3 to 1 cm in diameter which dimple sign may be positive. It can seen in any part of the body but extremities, especially legs are most common sites.

Physical Examination

Physical examination of patients with dermatofibroma is usually shows a non-tender, hyperpigmented nodule with 0.3 to 1 cm in diameter which dimple sign may be positive. It can seen in any part of the body but extremities, especially legs are most common sites.

Skin

https://www.dermnetnz.org/topics/dermatofibroma-images/
https://www.dermnetnz.org/topics/dermatofibroma-images/

Extremities

References

  1. ↑ Lee, MiWoo; Lee, WooJin; Jung, JoonMin; Won, ChongHyun; Chang, SungEun; Choi, JeeHo; Moon, KeeChan (2015). "Clinical and histological patterns of dermatofibroma without gross skin surface change: A comparative study with conventional dermatofibroma". Indian Journal of Dermatology, Venereology, and Leprology. 81 (3): 263. doi:10.4103/0378-6323.154795. ISSN 0378-6323.
  2. ↑ Mentzel, Thomas; Wiesner, Thomas; Cerroni, Lorenzo; Hantschke, Markus; Kutzner, Heinz; Rütten, Arno; Häberle, Michael; Bisceglia, Michele; Chibon, Frederic; Coindre, Jean-Michel (2012). "Malignant dermatofibroma: clinicopathological, immunohistochemical, and molecular analysis of seven cases". Modern Pathology. 26 (2): 256–267. doi:10.1038/modpathol.2012.157. ISSN 0893-3952.
  3. ↑ Fitzpatrick, Thomas B.; Gilchrest, Barbara A. (1977). "Dimple Sign to Differentiate Benign from Malignant Pigmented Cutaneous Lesions". New England Journal of Medicine. 296 (26): 1518–1518. doi:10.1056/NEJM197706302962610. ISSN 0028-4793.
  4. ↑ Marc Pusztaszeri, Pierre-Yves Jaquet & Carole Williamson (2011). "Giant hemosiderotic dermatofibroma: a case report and review of the literature". Case reports in dermatology. 3 (1): 32–36. doi:10.1159/000324721. PMID 21487458.
  5. ↑ L. Requena, M. C. Farina, C. Fuente, E. Pique, M. Olivares, L. Martin & E. Sanchez Yus (1994). "Giant dermatofibroma. A little-known clinical variant of dermatofibroma". Journal of the American Academy of Dermatology. 30 (5 Pt 1): 714–718. PMID 8176009.
  6. ↑ Şenel, E.; Yuyucu Karabulut, Y.; Doğruer Şenel, S. (2015). "Clinical, histopathological, dermatoscopic and digital microscopic features of dermatofibroma: a retrospective analysis of 200 lesions". Journal of the European Academy of Dermatology and Venereology. 29 (10): 1958–1966. doi:10.1111/jdv.13092. ISSN 0926-9959.
  7. ↑ Han, Tae Young; Chang, Hee Sun; Lee, June Hyun Kyung; Lee, Won-Mi; Son, Sook-Ja (2011). "A Clinical and Histopathological Study of 122 Cases of Dermatofibroma (Benign Fibrous Histiocytoma)". Annals of Dermatology. 23 (2): 185. doi:10.5021/ad.2011.23.2.185. ISSN 1013-9087.
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