eMedicine Specialties > Dermatology > Benign Neoplasms

Dermatofibroma: Follow-up

Author: Joseph C Pierson, MD, Consulting Staff, Department of Dermatology, Guthrie Army Clinic, Ft Drum, NY
Coauthor(s): Christine C Tam, MD, Staff Physician, Dermatology Office of David A Spott, MD
Contributor Information and Disclosures

Updated: Oct 2, 2009

Follow-up

Further Outpatient Care

  • If the dermatofibroma (DF) is not removed and significant change occurs in the color, size, border, or symptoms, the patient should seek follow-up evaluation.
  • If complete removal has been attempted, patients with lesions that recur should seek follow-up evaluation.
  • If multiple (ie, 15 or more) lesions develop, screening for autoimmune disease or altered immunity is indicated.

Prognosis

  • Dermatofibroma is considered a benign lesion, and the prognosis for patients with this condition is excellent. Reports of metastatic dermatofibroma are extremely rare, and the histologic diagnosis in those cases is disputable.
  • In a study of common dermatofibromas with an increased mitotic rate but no other worrisome features, none recurred or metastasized.39

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • All specimens that are removed should be submitted for histologic confirmation of the diagnosis of dermatofibroma.
  • A false-negative diagnosis of melanoma is the top reason for a malpractice claim against pathologists. In such cases, one of the common incorrect microscopic diagnoses is dermatofibroma.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Diane Pierson, MD, to the development and writing of this article.



More on Dermatofibroma

Overview: Dermatofibroma
Differential Diagnoses & Workup: Dermatofibroma
Treatment & Medication: Dermatofibroma
Follow-up: Dermatofibroma
Multimedia: Dermatofibroma
References
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References

  1. Chen TC, Kuo T, Chan HL. Dermatofibroma is a clonal proliferative disease. J Cutan Pathol. Jan 2000;27(1):36-9. [Medline].

  2. Kuroda K, Tajima S. Proliferation of HSP47-positive skin fibroblasts in dermatofibroma. J Cutan Pathol. Jan 2008;35(1):21-6. [Medline].

  3. Sellheyer K, Smoller BR. Dermatofibroma: upregulation of syndecan-1 expression in mesenchymal tissue. Am J Dermatopathol. Oct 2003;25(5):392-8. [Medline].

  4. Skroza N, Rotolo S, Ceccarelli S, et al. Modulation of the expression of the FGFR2-IIIb and FGFR2-IIIc molecules in dermatofibroma. J Dermatol Sci. Jul 2008;51(1):53-7. [Medline].

  5. Kubo M, Ihn H, Yamane K, Tamaki K. The expression levels and the differential expression of transforming growth factor-beta receptors in dermatofibroma and dermatofibrosarcoma protuberans. Br J Dermatol. May 2006;154(5):919-25. [Medline].

  6. Yamamoto T. Dermatofibroma: a possible model of local fibrosis with epithelial/mesenchymal cell interaction. J Eur Acad Dermatol Venereol. Apr 2009;23(4):371-5. [Medline].

  7. Colome-Grimmer MI, Evans HL. Metastasizing cellular dermatofibroma. A report of two cases. Am J Surg Pathol. Nov 1996;20(11):1361-7. [Medline].

  8. Kimyai-Asadi A, Goldberg LH, Greenberg C, et al. Cellular, atypical, and indeterminate dermatofibromas: benign or malignant?. Dermatol Surg. Sep 2008;34(9):1264-71; discussion 1271-2. [Medline].

  9. Gleason BC, Fletcher CD. Deep "benign" fibrous histiocytoma: clinicopathologic analysis of 69 cases of a rare tumor indicating occasional metastatic potential. Am J Surg Pathol. Mar 2008;32(3):354-62. [Medline].

  10. Lopez N, Fernandez A, Bosch RJ, Herrera E. Multiple eruptive dermatofibromas in a patient with Graves-Basedow disease. J Eur Acad Dermatol Venereol. Mar 2008;22(3):402-3. [Medline].

  11. Santos-Juanes J, Coto-Segura P, Mallo S, Galache C, Soto J. Multiple eruptive dermatofibromas in a patient receiving efalizumab. Dermatology. 2008;216(4):363. [Medline].

  12. De Unamuno P, Carames Y, Fernandez-Lopez E, Hernandez-Martin A, Pena C. Congenital multiple clustered dermatofibroma. Br J Dermatol. May 2000;142(5):1040-3. [Medline].

  13. Naversen DN, Trask DM, Watson FH, Burket JM. Painful tumors of the skin: "LEND AN EGG". J Am Acad Dermatol. Feb 1993;28(2 Pt 2):298-300. [Medline].

  14. Niemi KM. The benign fibrohistiocytic tumours of the skin. Acta Derm Venereol Suppl (Stockh). 1970;50(63):Suppl 63:1-66. [Medline].

  15. Cox NH. Halo asteatotic eczema localized around a dermatofibroma in acute-onset leg oedema. Br J Dermatol. Aug 2008;159(2):496. [Medline].

  16. Fitzpatrick TB, Gilchrest BA. Dimple sign to differentiate benign from malignant pigmented cutaneous lesions. N Engl J Med. Jun 30 1977;296(26):1518. [Medline].

  17. Meffert JJ, Peake MF, Wilde JL. 'Dimpling' is not unique to dermatofibromas. Dermatology. 1997;195(4):384-6. [Medline].

  18. Samlaska C, Bennion S. Eruptive dermatofibromas in a kindred. Cutis. Mar 2002;69(3):187-8, 190. [Medline].

  19. Zaballos P, Puig S, Llambrich A, Malvehy J. Dermoscopy of dermatofibromas: a prospective morphological study of 412 cases. Arch Dermatol. Jan 2008;144(1):75-83. [Medline].

  20. Cavicchini S, Tourlaki A, Tanzi C, Alessi E. Dermoscopy of solitary yellow lesions in adults. Arch Dermatol. Oct 2008;144(10):1412. [Medline].

  21. Demir MK, Ozdemir H, Gençhallaç H, Altaner S, Kartal O. Dermatofibroma mimicking malignancy on integrated F-18 fluorodeoxyglucose PET-CT. Diagn Interv Radiol. Mar 2009;15(1):61-3. [Medline].

  22. Kideryova L, Lacina L, Dvorankova B, et al. Phenotypic characterization of human keratinocytes in coculture reveals differential effects of fibroblasts from benign fibrous histiocytoma (dermatofibroma) as compared to cells from its malignant form and to normal fibroblasts. J Dermatol Sci. Jul 2009;55(1):18-26. [Medline].

  23. Nair V, Weinreb I, MacNeil N, Szollosi Z, Chetty R, Ghazarian D. A unique biphasic variant of cutaneous fibrous histiocytoma with a storiform pattern and intralesional pigmented melanocytes: "storiform melano-fibrous histiocytoma". Eur J Dermatol. May-Jun 2008;18(3):332-6. [Medline].

  24. Goldblum JR, Tuthill RJ. CD34 and factor-XIIIa immunoreactivity in dermatofibrosarcoma protuberans and dermatofibroma. Am J Dermatopathol. Apr 1997;19(2):147-53. [Medline].

  25. Kim HJ, Lee JY, Kim SH, et al. Stromelysin-3 expression in the differential diagnosis of dermatofibroma and dermatofibrosarcoma protuberans: comparison with factor XIIIa and CD34. Br J Dermatol. Aug 2007;157(2):319-24. [Medline].

  26. Horenstein MG, Prieto VG, Nuckols JD, Burchette JL, Shea CR. Indeterminate fibrohistiocytic lesions of the skin: is there a spectrum between dermatofibroma and dermatofibrosarcoma protuberans?. Am J Surg Pathol. Jul 2000;24(7):996-1003. [Medline].

  27. Mori T, Misago N, Yamamoto O, Toda S, Narisawa Y. Expression of nestin in dermatofibrosarcoma protuberans in comparison to dermatofibroma. J Dermatol. Jul 2008;35(7):419-25. [Medline].

  28. Zelger BG, Zelger B. [Dermatofibroma. A clinico-pathologic classification scheme]. Pathologe. Nov 1998;19(6):412-9. [Medline].

  29. Gonzalez-Vela MC, Val-Bernal JF, Martino M, Gonzalez-Lopez MA, Garcia-Alberdi E, Hermana S. Sclerotic fibroma-like dermatofibroma: an uncommon distinctive variant of dermatofibroma. Histol Histopathol. Jul 2005;20(3):801-6. [Medline].

  30. de Feraudy S, Mar N, McCalmont TH. Evaluation of CD10 and procollagen 1 expression in atypical fibroxanthoma and dermatofibroma. Am J Surg Pathol. Aug 2008;32(8):1111-22. [Medline].

  31. Spaun E, Zelger B. Dermatofibroma with intracytoplasmic eosinophilic globules: an unusual phenomenon. J Cutan Pathol. Jul 2009;36(7):796-8. [Medline].

  32. Garrido-Ruiz MC, Carrillo R, Enguita AB, Peralto JL. Signet-ring cell dermatofibroma. Am J Dermatopathol. Feb 2009;31(1):84-7. [Medline].

  33. Gonzalez S. Regarding the case report of Dr Phillip W. Allen on apocrine gland cyst with hemosiderotic dermatofibroma. Adv Anat Pathol. Nov 2008;15(6):376; author reply 376. [Medline].

  34. King R, Googe PB, Page RN, Mihm MC Jr. Melanocytic lesions associated with dermatofibromas: a spectrum of lesions ranging from junctional nevus to malignant melanoma in situ. Mod Pathol. Aug 2005;18(8):1043-7. [Medline].

  35. Kovach BT, Boyd AS. Melanoma associated with a dermatofibroma. J Cutan Pathol. May 2007;34(5):420-2. [Medline].

  36. Orrock JM, Abbott JJ, Gibson LE, Folpe AL. INI1 and GLUT-1 expression in epithelioid sarcoma and its cutaneous neoplastic and nonneoplastic mimics. Am J Dermatopathol. Apr 2009;31(2):152-6. [Medline].

  37. Weber PJ, Moody BR, Foster JA. Inverted pyramidal biopsy. Dermatol Surg. Jul 2001;27(7):681-4. [Medline].

  38. Krupa Shankar DS, Kushalappa AA, Suma KS, Pai SA. Multiple dermatofibromas on face treated with carbon dioxide laser. Indian J Dermatol Venereol Leprol. May-Jun 2007;73(3):194-5. [Medline].

  39. Fernandez-Flores A, Manjon JA. Mitosis in dermatofibroma: a worrisome histopathologic sign that does not necessarily equal recurrence. J Cutan Pathol. Sep 2008;35(9):839-42. [Medline].

  40. Aiba S, Terui T, Tagami H. Dermatofibroma with diffuse eosinophilic infiltrate. Am J Dermatopathol. Jun 2000;22(3):281-4. [Medline].

  41. Alexandrescu DT, Wiernik PH. Multiple eruptive dermatofibromas occurring in a patient with chronic myelogenous leukemia. Arch Dermatol. Mar 2005;141(3):397-8. [Medline].

  42. Aydin E, Vardareli OS, Bilezikci B, Ozgirgin ON. [Dermatofibroma accompanied by perforating dermatosis in the auricle: a case report]. Kulak Burun Bogaz Ihtis Derg. 2005;15(3-4):83-6. [Medline].

  43. Curcó N, Jucgla A, Bordas X, Moreno A. Dermatofibroma with spreading satellitosis. J Am Acad Dermatol. Dec 1992;27(6 Pt 1):1017-9. [Medline].

  44. Evans J, Clarke T, Mattacks CA, Pond CM. Dermatofibromas and arthropod bites: is there any evidence to link the two?. Lancet. Jul 1 1989;2(8653):36-7. [Medline].

  45. Fuciarelli K, Cohen PR. Sebaceous hyperplasia: a clue to the diagnosis of dermatofibroma. J Am Acad Dermatol. Jan 2001;44(1):94-5. [Medline].

  46. Heenan PJ. Tumors of the fibrous tissue involving the skin. In: Elder D, ed. Lever's Histopathology of the Skin. 8th ed. Philadelphia, Pa: Lippincott-Raven; 1997:847-53.

  47. Hong SB, Yang MH, Lee MH, Haw CR. Dermatofibroma-like atypical granular cell tumour. Acta Derm Venereol. 2005;85(2):179-80. [Medline].

  48. Lookingbill DP. A malignant dimple. N Engl J Med. Oct 13 1977;297(15):841-2. [Medline].

  49. Requena L, Farina MC, Fuente C, et al. Giant dermatofibroma. A little-known clinical variant of dermatofibroma. J Am Acad Dermatol. May 1994;30(5 Pt 1):714-8. [Medline].

  50. Sanchez RL. The elusive dermatofibromas. Arch Dermatol. Apr 1990;126(4):522-3. [Medline].

  51. Shinojima Y, Hara H, Shimojima H, Terui T. Cutaneous chondroma with overlying pigmentation clinically mimicking dermatofibroma. Br J Dermatol. Jan 2006;154(1):178-81. [Medline].

  52. Sánchez Yus E, Soria L, de Eusebio E, Requena L. Lichenoid, erosive and ulcerated dermatofibromas. Three additional clinico-pathologic variants. J Cutan Pathol. Mar 2000;27(3):112-7. [Medline].

  53. Troxel DB. An insurer's perspective on error and loss in pathology. Arch Pathol Lab Med. Oct 2005;129(10):1234-6. [Medline].

  54. Wick MR, Ritter JH, Lind AC, Swanson PE. The pathological distinction between "deep penetrating" dermatofibroma and dermatofibrosarcoma protuberans. Semin Cutan Med Surg. Mar 1999;18(1):91-8. [Medline].

  55. Zelger B, Zelger BG, Burgdorf WH. Dermatofibroma-a critical evaluation. Int J Surg Pathol. Oct 2004;12(4):333-44. [Medline].

  56. Zelger BG, Sidoroff A, Zelger B. Combined dermatofibroma: co-existence of two or more variant patterns in a single lesion. Histopathology. Jun 2000;36(6):529-39. [Medline].

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Further Reading

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Keywords

dermatofibroma, benign fibrous histiocytoma, dermal dendrocytoma, dermatofibroma lenticulare, fibroma durum, fibroma simplex, histiocytoma, histiocytoma cutis, nodular subepidermal fibrosis, sclerosing angioma, sclerosing hemangioma

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Contributor Information and Disclosures

Author

Joseph C Pierson, MD, Consulting Staff, Department of Dermatology, Guthrie Army Clinic, Ft Drum, NY
Joseph C Pierson, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Coauthor(s)

Christine C Tam, MD, Staff Physician, Dermatology Office of David A Spott, MD
Christine C Tam, MD is a member of the following medical societies: American Medical Association, Phi Beta Kappa, and Phi Kappa Phi
Disclosure: Nothing to disclose.

Medical Editor

Terry L Barrett, MD, Clinical Professor of Dermatology and Pathology, University of Texas Southwestern School of Medicine; Director, ProPath Dermatopathology, Dallas, Texas
Terry L Barrett, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Medical Association, American Society of Dermatopathology, College of American Pathologists, and United States and Canadian Academy of Pathology
Disclosure: Nothing to disclose.

Pharmacy Editor

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.

Managing Editor

Edward F Chan, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine
Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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