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Dermatofibroma Follow-up

  • Author: Joseph C Pierson, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Mar 03, 2016
 

Further Outpatient Care

If the dermatofibroma 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 previously attempted, patients with lesions that recur should seek follow-up evaluation. An aggressive subtype or another diagnosis should be ruled out.

If multiple eruptive lesions develop, screening for a family history of such and for underlying associated diseases and medications is warranted (See History).

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Prognosis

Typical superficial dermatofibromas are considered benign lesions, and the prognosis for patients with this condition is excellent. However, discomfort from pain or itching may be significant.

Deep, cellular, aneurysmal (hemosiderotic), and atypical variants, which are notoriously more locally recurrent (≤20% of cases), can rarely metastasize.[113, 114, 115] (The deep subset of dermatofibroma that arises in the subcutaneous or deep soft tissue may undergo further classification.[114] ) Such variants, or any indeterminant dermatofibroma, might be regarded as potentially malignant lesions.[116] In these exceptional cases, pulmonary and nodal metastases were most commonly seen, some patients developed multiple satellite nodules, and deaths have occurred.[117] The primary tumors tended to be large and cellular, but aggressive behavior is not entirely predictable, although early or frequent recurrences of the tumor should raise concern.[117] Array-based comparative genomic hybridization (CGH) may prove useful in identifying these higher-risk variants.[118, 119, 114]

The epithelioid variant has also been reported to metastasize, although demonstration of ALK gene rearrangement may indicate it is a biologically distinct tumor.[12]

In a study of common dermatofibromas with an increased mitotic rate but no other worrisome features, none recurred or metastasized.[120]

Spontaneous regression has been reported,[121] and this may yield postinflammatory hypopigmentation, although this appears to be quite rare.

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Patient Education

For patient education resources, see the Procedures Center, as well as Mole Removal.

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Contributor Information and Disclosures
Author

Joseph C Pierson, MD Dermatology Residency Program Director, University of Vermont College of Medicine

Joseph C Pierson, MD is a member of the following medical societies: Association of Professors of Dermatology, New England Dermatological Society, American Academy of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Christine C Tam, MD Managing Member, Certified Dermatologists

Christine C Tam, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

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

Disclosure: Nothing to disclose.

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, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

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

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Erythematous, slightly hyperpigmented nodule on the leg. Courtesy of David Barnette, MD.
Acanthotic epithelium with basilar hyperpigmentation (dirty feet) over a dermal spindle cell proliferation (X10). Courtesy of David Barnette, MD.
Collagen trapping by the dermal fibrohistiocytic infiltrate (X40). Courtesy of David Barnette, MD.
 
 
 
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