Dermatofibroma physical examination
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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
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
Extremities
- Hard papules (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 of patients with [disease name] is usually normal.
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].
Skin
- Skin examination of patients with dermatofibroma may shows:
- Nodule with 0.3 to 1 cm in diameter
- Hyperpigmented
- Dimple sign ( lateral compression on the skin makes a depression)
- Puritic ( may happen by manipulation)
- Typically, the clinical appearance of dermatofibroma is a solitary, 0.5- to 1-cm nodule. A sizable minority of patients may have several lesions, but rarely (< 1% of cases) are more than 15 lesions present. (See History) The overlying skin can range from flesh to gray, yellow, orange, pink, red, purple, blue, brown, or black, or a combination of hues (see the image below). On palpation, the hard nodule may feel like a small pebble fixed to the skin surface and is freely movable over the subcutis. Tenderness may be elicited with manipulation of the lesion. The characteristic tethering of the overlying epidermis to the underlying lesion with lateral compression (pinching), called the dimple sign, may be a useful clinical sign for diagnosis. [49] However, presence of the dimple sign does not always assure the lesion is dermatofibroma, [50] and dermatoscopy may be useful in supporting the clinical impression. [51] The extremities are the most common sites of involvement, particularly the legs.[19, 20] Although any cutaneous site can be seen, palm, sole, digital, oral, and genital involvement is relatively rare. Giant (>5 cm in diameter), [52] atrophic, [53]polypoid, [54] and dermatofibroma with spreading satellitosis [55] variants have been reported. The largest reported tumor was 17 x 9 x 4 cm. [56] Multiple clustered dermatofibromas [48] are rare and can mimic dermatofibrosarcoma protuberans. This phenomenon has been reported in a segmental distribution. [57] A halo of dermatitis (Meyerson phenomenon) surrounding a dermatofibroma occurred in one patient.
Dermatofibromas typically present as firm, often hyperpigmented, nodules 0.3 to 1 cm in diameter (picture 4A-B), but giant lesions larger than 3 cm in diameter have been described [11,12]. They occur most often in adults and are most commonly located on the lower extremities. Lesions are usually asymptomatic, but may be pruritic. On palpations, dermatofibromas are fixed to the subcutaneous tissues and characteristically dimple when pinched
Extremities
- Extremities examination of patients with [disease name] is usually normal.
OR
- Clubbing
- Cyanosis
- Pitting/non-pitting edema of the upper/lower extremities
- Muscle atrophy
- Fasciculations in the upper/lower extremity