Dermatofibroma overview: Difference between revisions
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{{Dermatofibroma}} | {{Dermatofibroma}} | ||
{{CMG}}, {{AE}}{{Faizan}} | {{CMG}}, {{AE}}{{Homa}}{{Faizan}} | ||
==Overview== | ==Overview== | ||
Dermatofibroma is a common [[benign]] [[skin lesion]] which may [[Development|develop]] in all age group. Although, it is more occurred in 20s to 40s ages. The majority of [[patients]] with dermatofibroma are [[asymptomatic]]. It mostly [[Development|develops]] as a single slow [[Growth|growing]] [[lesion]] on an [[Limb|extremity]]. [[Trauma|Traumatized]] [[lesion]] may cause [[pain]], [[bleeding]], i[[Itching|tching]], erosive changes,and [[ulceration]]. [[Physical examination]] of [[patients]] with dermatofibroma is usually shows a non-[[Tenderness|tender]], [[Hyperpigmentation|hyperpigmented]] [[Nodule (medicine)|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. Dermatofibroma is primarily diagnosed based on the [[clinical]] presentation and history. They are [[benign]] and no treatment is generally needed. If the treatment is needed, [[local]] [[excision]] is the mainstay one. | |||
==Historical Perspective== | ==Historical Perspective== | ||
Dermatofibroma was first discovered by Unna, in 1894. He named it as "fibroma durum". | |||
==Classification== | ==Classification== | ||
Dermatofibroma may be classified according to [[histopathology]] into three groups, variants that are prominent in architectural (low-power) properties, variants that are prominent in [[Cytological|cytologic]] or [[stromal]] (high-power) properties, and variants that have architectural (low) and [[cytological]] or [[stromal]] (high-power) properties. | |||
==Pathophysiology== | ==Pathophysiology== | ||
The exact pathogenesis of dermatofibroma is not fully understood. Although some mechanisms are suggested in the [[pathogenesis]] of this disease that include, reactive [[tissue]] changes, [[neoplastic]] [[proliferation]], the cell surface [[proteoglycan]], [[Syndecan 1|syndecan-1]], and [[fibroblast growth factor receptor 2]] may play a role in the [[growth]] of dermatofibromas, [[Transforming growth factor-β|transforming growth factor-beta]] ([[TGF-beta]]) [[Signaling pathway|signaling]] may be involved in the [[development]] of [[fibrosis]] in [[dermatofibroma]], and the presence of [[Factor XIII|factor XIIIa]] and [[CD]]168 suggests that dermatofibroma can originate from the [[dermal]] [[dendritic cell]]. On [[gross pathology]], firm yellowish [[papules]] which may have areas of [[hemorrhage]] and lipidization are characteristic findings of dermatofibroma. Microscopically dermatofibroma is characterized by localized [[nodular]] [[proliferation]] of [[spindle]]-shaped [[fibrous]] [[Cells (biology)|cells]] in a [[mixture]] of [[Histiocyte|histocytoid]] [[Cells (biology)|cells]] inside the [[dermis]], spiculated margin of cells, “Storiform” [[pattern]] which defines as whorls of elongated [[nuclei]], [[collagen]] bundles that usually seen inside and between the [[fascicles]] of [[Spindle|spindled]] [[fibrous]] [[cells]], "Grenz zone" which is an unaffected layer that separates the overlying [[epidermis]] from the [[dermis]], and [[epidermal]] [[hyperplasia]]. | |||
==Causes== | ==Causes== | ||
The [[causes]] of dermatofibroma has not been identified. | |||
== | ==Differentiating Dermatofibroma from Other Diseases== | ||
Dermatofibroma must be [[Differentiate|differentiated]] from other common [[causes]] of [[skin lesions]], such as [[basal cell carcinoma]], [[dermatofibrosarcoma protuberans]], and [[Kaposi sarcoma]]. | |||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
Dermatofibroma is a common [[benign]] [[skin lesion]] that is seen in almost 3000 dermatophatology [[laboratory]] specimens per 100,000 ones. As most of [[patients]] with dermatofibroma are [[asymptomatic]], the worldwide [[incidence]] of dermatofibroma is unknown. [[Patients]] of all age groups may develop dermatofibroma. Although, it is more occurred in 20s to 40s ages. There is no [[racial]] predilection to dermatofibroma. [[Female]] are more commonly affected by dermatofibroma than [[male]]. The [[female]] to [[male]] [[ratio]] is approximately 2 to 1. Dermatofibromas are [[benign]] and no treatment is generally needed. If the treatment is needed, [[local]] [[excision]] is the mainstay one. | |||
==Risk Factors== | ==Risk Factors== | ||
There are no established [[risk factors]] for dermatofibroma. Although, It is believed that minor [[trauma]] or a low-grade [[benign]] [[neoplasm]] can have role. | |||
==Screening== | ==Screening== | ||
There is insufficient evidence to recommend routine [[screening]] for dermatofibroma. | |||
==Natural History, Complications, and Prognosis== | |||
Dermatofibroma usually [[Development|develops]] in the third decade of life, and most of them are [[asymptomatic]]. Common [[complications]] of dermatofibroma are related to [[Excision|excisional]] removing of the [[lesion]] and include, [[bleeding]], [[infection]] and [[scar]]. [[Prognosis]] is generally excellent. Although, in very [[rare]] cases [[metastases]] are seen. | |||
==Diagnosis== | |||
===Diagnostic Study of Choice=== | |||
Dermatofibroma is primarily diagnosed based on the [[clinical]] presentation and history. | |||
===History and Symptoms=== | |||
The majority of [[patients]] with dermatofibroma are [[asymptomatic]]. Dermatofibroma mostly develops as a single slow growing [[lesion]] on an extremity. Traumatized [[lesion]] may cause [[pain]], [[bleeding]], i[[Itching|tching]], erosive changes,and [[ulceration]]. | |||
Multiple dermatofibromas is a [[rare]] variant of [[disease]] which mostly seen in [[patients]] with underlying [[systemic]] [[disorders]]. | |||
===Physical Examination=== | |||
[[Physical examination]] of [[patients]] with dermatofibroma is usually shows a non-tender, [[hyperpigmented]] [[Nodule (medicine)|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. | |||
===Laboratory Findings=== | |||
There are no [[diagnostic]] [[laboratory]] findings associated with dermatofibroma. | |||
===Electrocardiogram=== | |||
There are no [[ECG]] findings associated with dermatofibroma. | |||
===X-ray=== | |||
There are no [[X-rays|x-ray]] findings associated with dermatofibroma. | |||
== | ===Ultrasound=== | ||
[[Ultrasound]] may be helpful in the [[diagnosis]] of dermatofibroma. Findings on an [[ultrasound]] suggestive of dermatofibroma include hypoechoic [[solid]] [[nodule]], [[avascular]] [[lesion]] within the [[dermis]], and unwell defined [[margin]]. | |||
===CT scan=== | |||
There are no [[CT scan]] findings associated with dermatofibroma. | |||
== | ===MRI=== | ||
There are no [[MRI]] findings associated with dermatofibroma. | |||
== | ===Other Imaging Findings=== | ||
There are no other [[imaging]] findings associated with dermatofibroma. | |||
== | ===Other Diagnostic Studies=== | ||
[[Dermatoscopy]] may be helpful in the [[diagnosis]] of dermatofibroma. Findings suggestive of dermatofibroma include [[central]] white patch with peripheral network of [[Pigmentation|pigmentation.]] | |||
==Treatment== | ==Treatment== | ||
===Medical Therapy=== | |||
Dermatofibromas are [[benign]] and no treatment is generally needed. If the treatment is needed, [[local]] [[excision]] is the mainstay one. | |||
=== Interventions === | |||
[[Carbon dioxide laser|Carbon dioxide]] and pulsed-dye laser can be used for the treatment of dermatofibroma. | |||
===Surgery=== | |||
[[Surgery]] is the first-line treatment option for [[patients]] with dermatofibroma. Surgery is usually used for patients with either [[Cosmetics|cosmetic]] reasons, [[symptomatic]] [[lesions]], uncertain [[diagnosis]] and aggressive subtypes. | |||
Complete [[excision]] which is involved [[subcutaneous fat]] incorporated with 1-3 mm margin based on the location of [[Lesions|lesion]] is recommended. [[Cryosurgery]] or [[superficial]] shaving as a purpose of cosmetic or controlling [[symptoms]] are accompanied by increasing risk of recurrence. | |||
===Primary Prevention=== | |||
There are no established measures for the [[primary prevention]] of dermatofibroma. | |||
===Secondary Prevention=== | |||
There are no established measures for the [[secondary prevention]] of dermatofibroma. | |||
== | ==References== | ||
{{reflist|2}} | |||
[[Category: | [[Category:Medicine]] | ||
[[Category:Oncology]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Dermatology]] | [[Category:Dermatology]] | ||
[[Category: | [[Category:Surgery]] | ||
Latest revision as of 21:18, 29 July 2020
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Dermatofibroma overview On the Web |
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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]Faizan Sheraz, M.D. [3]
Overview
Dermatofibroma is a common benign skin lesion which may develop in all age group. Although, it is more occurred in 20s to 40s ages. The majority of patients with dermatofibroma are asymptomatic. It mostly develops as a single slow growing lesion on an extremity. Traumatized lesion may cause pain, bleeding, itching, erosive changes,and ulceration. 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. Dermatofibroma is primarily diagnosed based on the clinical presentation and history. They are benign and no treatment is generally needed. If the treatment is needed, local excision is the mainstay one.
Historical Perspective
Dermatofibroma was first discovered by Unna, in 1894. He named it as "fibroma durum".
Classification
Dermatofibroma may be classified according to histopathology into three groups, variants that are prominent in architectural (low-power) properties, variants that are prominent in cytologic or stromal (high-power) properties, and variants that have architectural (low) and cytological or stromal (high-power) properties.
Pathophysiology
The exact pathogenesis of dermatofibroma is not fully understood. Although some mechanisms are suggested in the pathogenesis of this disease that include, reactive tissue changes, neoplastic proliferation, the cell surface proteoglycan, syndecan-1, and fibroblast growth factor receptor 2 may play a role in the growth of dermatofibromas, transforming growth factor-beta (TGF-beta) signaling may be involved in the development of fibrosis in dermatofibroma, and the presence of factor XIIIa and CD168 suggests that dermatofibroma can originate from the dermal dendritic cell. On gross pathology, firm yellowish papules which may have areas of hemorrhage and lipidization are characteristic findings of dermatofibroma. Microscopically dermatofibroma is characterized by localized nodular proliferation of spindle-shaped fibrous cells in a mixture of histocytoid cells inside the dermis, spiculated margin of cells, “Storiform” pattern which defines as whorls of elongated nuclei, collagen bundles that usually seen inside and between the fascicles of spindled fibrous cells, "Grenz zone" which is an unaffected layer that separates the overlying epidermis from the dermis, and epidermal hyperplasia.
Causes
The causes of dermatofibroma has not been identified.
Differentiating Dermatofibroma from Other Diseases
Dermatofibroma must be differentiated from other common causes of skin lesions, such as basal cell carcinoma, dermatofibrosarcoma protuberans, and Kaposi sarcoma.
Epidemiology and Demographics
Dermatofibroma is a common benign skin lesion that is seen in almost 3000 dermatophatology laboratory specimens per 100,000 ones. As most of patients with dermatofibroma are asymptomatic, the worldwide incidence of dermatofibroma is unknown. Patients of all age groups may develop dermatofibroma. Although, it is more occurred in 20s to 40s ages. There is no racial predilection to dermatofibroma. Female are more commonly affected by dermatofibroma than male. The female to male ratio is approximately 2 to 1. Dermatofibromas are benign and no treatment is generally needed. If the treatment is needed, local excision is the mainstay one.
Risk Factors
There are no established risk factors for dermatofibroma. Although, It is believed that minor trauma or a low-grade benign neoplasm can have role.
Screening
There is insufficient evidence to recommend routine screening for dermatofibroma.
Natural History, Complications, and Prognosis
Dermatofibroma usually develops in the third decade of life, and most of them are asymptomatic. Common complications of dermatofibroma are related to excisional removing of the lesion and include, bleeding, infection and scar. Prognosis is generally excellent. Although, in very rare cases metastases are seen.
Diagnosis
Diagnostic Study of Choice
Dermatofibroma is primarily diagnosed based on the clinical presentation and history.
History and Symptoms
The majority of patients with dermatofibroma are asymptomatic. Dermatofibroma mostly develops as a single slow growing lesion on an extremity. Traumatized lesion may cause pain, bleeding, itching, erosive changes,and ulceration.
Multiple dermatofibromas is a rare variant of disease which mostly seen in patients with underlying systemic disorders.
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.
Laboratory Findings
There are no diagnostic laboratory findings associated with dermatofibroma.
Electrocardiogram
There are no ECG findings associated with dermatofibroma.
X-ray
There are no x-ray findings associated with dermatofibroma.
Ultrasound
Ultrasound may be helpful in the diagnosis of dermatofibroma. Findings on an ultrasound suggestive of dermatofibroma include hypoechoic solid nodule, avascular lesion within the dermis, and unwell defined margin.
CT scan
There are no CT scan findings associated with dermatofibroma.
MRI
There are no MRI findings associated with dermatofibroma.
Other Imaging Findings
There are no other imaging findings associated with dermatofibroma.
Other Diagnostic Studies
Dermatoscopy may be helpful in the diagnosis of dermatofibroma. Findings suggestive of dermatofibroma include central white patch with peripheral network of pigmentation.
Treatment
Medical Therapy
Dermatofibromas are benign and no treatment is generally needed. If the treatment is needed, local excision is the mainstay one.
Interventions
Carbon dioxide and pulsed-dye laser can be used for the treatment of dermatofibroma.
Surgery
Surgery is the first-line treatment option for patients with dermatofibroma. Surgery is usually used for patients with either cosmetic reasons, symptomatic lesions, uncertain diagnosis and aggressive subtypes.
Complete excision which is involved subcutaneous fat incorporated with 1-3 mm margin based on the location of lesion is recommended. Cryosurgery or superficial shaving as a purpose of cosmetic or controlling symptoms are accompanied by increasing risk of recurrence.
Primary Prevention
There are no established measures for the primary prevention of dermatofibroma.
Secondary Prevention
There are no established measures for the secondary prevention of dermatofibroma.