Acquired Digital Fibrokeratoma Workup

  • Author: Elizabeth Kline Satter, MD, MPH; Chief Editor: William D James, MD   more...
 
Updated: Jul 11, 2011
 

Histologic Findings

The overall architecture of an acquired digital fibrokeratoma is a small, well-circumscribed, dome-shaped or narrow elongated papule. The stratum corneum is typically hyperkeratotic, which tends to be most pronounced toward the summit of the lesion. The epidermis can be acanthotic, with elongation of the rete ridges or can be slightly attenuated.

The dermal core of an acquired digital fibrokeratoma displays 1 of 3 histological patterns, which were originally described by Bart et al[1] and further characterized by Kint et al.[16] Type I acquired digital fibrokeratoma is the most common type and consists of a dermal core composed of thick, closely intertwined collagen bundles that are often oriented along the vertical axis of the lesion. Between the collagen bundles are numerous capillaries, varying numbers of fibroblasts, and thin elastic fibers. Type II lesions are less common, and histologically resemble type I lesions, but in addition have a significantly increased number of fibroblasts arranged in fascicles and markedly reduced numbers of elastic fibers. Type III acquired digital fibrokeratoma is the least common type and consists of a dermal core that is poorly cellular and edematous with a reduced number of elastic fibers.

Domed-shaped papule with overlying hyperkeratosis.Domed-shaped papule with overlying hyperkeratosis. The dermal core is composed of increased collagen bundles and blood vessels oriented along the vertical axis of the lesion. Close up showing the increased collagen bundles anClose up showing the increased collagen bundles and blood vessels oriented along the vertical axis of the lesion. A different acquired digital fibrokeratoma showingA different acquired digital fibrokeratoma showing similar findings of a domed-shaped lesion with a vertically aligned fibrovascular core.
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Contributor Information and Disclosures
Author

Elizabeth Kline Satter, MD, MPH  Director of Dermatopathology, Naval Medical Center San Diego

Elizabeth Kline Satter, MD, MPH is a member of the following medical societies: Alpha Omega Alpha and American Medical Women's Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Abby S Van Voorhees, MD  Assistant Professor, Director of Psoriasis Services and Phototherapy Units, Department of Dermatology, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania

Abby S Van Voorhees, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, National Psoriasis Foundation, Phi Beta Kappa, Sigma Xi, and Women's Dermatologic Society

Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Merck Salary Management position; Abbott Honoraria Speaking and teaching; Amgen Honoraria Review panel membership; Centocor Honoraria Consulting; Leo Consulting; Merck None Other

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Christen M Mowad, MD  Associate Professor, Department of Dermatology, Geisinger Medical Center

Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Dermatological Association, Noah Worcester Dermatological Society, Pennsylvania Academy of Dermatology, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

References

  1. Bart RS, Andrade R, Kopf AW, Leider M. Acquired digital fibrokeratomas. Arch Dermatol. Feb 1968;97(2):120-9. [Medline].

  2. Pinkus H. Discussion - Acquired digital fibrokeratoma. Arch Dermatol. 1968;97:128-9.

  3. Verallo VV. Acquired digital fibrokeratomas. Br J Dermatol. Nov 1968;80(11):730-6. [Medline].

  4. Carlson RM, Lloyd KM, Campbell TE. Acquired periungual fibrokeratoma: a case report. Cutis. Aug 2007;80(2):137-40. [Medline].

  5. Qiao J, Liu YH, Fang K. Acquired digital fibrokeratoma associated with ciclosporin treatment. Clin Exp Dermatol. Mar 2009;34(2):257-9. [Medline].

  6. Kint A, Baran R. Histopathologic study of Koenen tumors. Are they different from acquired digital fibrokeratoma?. J Am Acad Dermatol. Feb 1988;18(2 Pt 1):369-72. [Medline].

  7. Bron C, Noel B, Panizzon RG. Giant fibrokeratoma of the heel. Dermatology. 2004;208(3):271-2. [Medline].

  8. Spitalny AD, Lavery LA. Acquired fibrokeratoma of the heel. J Foot Surg. Sep-Oct 1992;31(5):509-11. [Medline].

  9. de Freitas PM, de Sb Xavier MH, Pereira GB, et al. Acquired fibrokeratoma presenting as a giant pedunculated lesion on the heel. Dermatol Online J. Dec 15 2008;14(12):10. [Medline].

  10. Baykal C, Buyukbabani N, Yazganoglu KD, Saglik E. Acquired digital fibrokeratoma. Cutis. Feb 2007;79(2):129-32. [Medline].

  11. Kakurai M, Yamada T, Kiyosawa T, Ohtsuki M, Nakagawa H. Giant acquired digital fibrokeratoma. J Am Acad Dermatol. May 2003;48(5 Suppl):S67-8. [Medline].

  12. Vinson RP, Angeloni VL. Acquired digital fibrokeratoma. Am Fam Physician. Oct 1995;52(5):1365-7. [Medline].

  13. Moulin G, Balme B, Thomas L. Familial multiple acral mucinous fibrokeratomas. J Am Acad Dermatol. Jun 1998;38(6 Pt 1):999-1001. [Medline].

  14. Dominguez-Cherit J, Garcia C, Vega-Memije ME, Arenas R. Pseudo-fibrokeratoma: an unusual presentation of subungual squamous cell carcinoma in a young girl. Dermatol Surg. Jul 2003;29(7):788-9. [Medline].

  15. Chi CC, Kuo TT, Wang SH. Aggressive digital papillary adenocarcinoma: a silent malignancy masquerading as acquired digital fibrokeratoma. Am J Clin Dermatol. 2007;8(4):243-5. [Medline].

  16. Kint A, Baran R, De Keyser H. Acquired (digital) fibrokeratoma. J Am Acad Dermatol. May 1985;12(5 Pt 1):816-21. [Medline].

  17. Nickel WR, Reed WB. Tuberous sclerosis. Special reference to the microscopic alterations in the cutaneous hamartomas. Arch Dermatol. Feb 1962;85:209-26. [Medline].

  18. Hare PJ, Smith PA. Acquired (digital) fibrokeratoma. Br J Dermatol. Sep 1969;81(9):667-70. [Medline].

  19. Hemric JR, Allen HB. Acquired digital fibrokeratoma. Cutis. Mar 1979;23(3):304-6. [Medline].

  20. Jaiswal AK, Chatterjee M. Acquired (digital) fibrokeratoma. Indian J Dermatol Venereol Leprol. May-Jun 2002;68(3):179-80. [Medline].

  21. Kumari R, Thappa DM, Devi A. Periunungal acquired digital fibrokeratoma. Indian J Dermatol Venereol Leprol. 2009;75:72.

  22. Saito S, Ishikawa K. Acquired periungual fibrokeratoma with accessory germinal matrix. J Hand Surg [Br]. Dec 2002;27(6):549-55. [Medline].

 
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Clinical picture of a pedunculated acquire digital fibrokeratoma.
Flat-topped, skin-colored acquired digital fibrokeratoma in an acral location.
Slightly raised skin encircling the base of an acquired digital fibrokeratoma, creating a moat.
Domed-shaped papule with overlying hyperkeratosis. The dermal core is composed of increased collagen bundles and blood vessels oriented along the vertical axis of the lesion.
Close up showing the increased collagen bundles and blood vessels oriented along the vertical axis of the lesion.
A different acquired digital fibrokeratoma showing similar findings of a domed-shaped lesion with a vertically aligned fibrovascular core.
 
 
 
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