Dermatofibroma Treatment & Management

Updated: Aug 07, 2020
  • Author: Joseph C Pierson, MD; Chief Editor: Dirk M Elston, MD  more...
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Treatment

Approach Considerations

No treatment is usually necessary for dermatofibromas. Simple reassurance that the lesion is benign may be indicated, unless one of the aggressive subtypes is suspected or diagnosed.

Intralesional steroid injections have been attempted with variable results.

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Surgical Care

For cosmetically unacceptable lesions, those that are particularly symptomatic, if there is any diagnostic uncertainty, or when one of the aggressive subtypes is suspected, complete excision, including the subcutaneous fat, is the ideal procedure. Obtaining a 3-mm margin has been shown to completely remove typical dermatofibromas. [131] One of the aggressive histologic subtypes, aneurysmal dermatofibroma, has been successfully treated via Mohs micrographic surgery. [132]  Mohs surgery has also been used for dermatofibromas of the face. [133]

An inverted pyramidal biopsy technique may allow for an aesthetically pleasing result, while still providing adequate tissue for histologic findings. [134]

Superficially shaving the lesion or cryosurgery can be attempted for cosmesis or to decrease the symptoms; however, recurrences are more likely.

Carbon dioxide and pulsed-dye laser treatments have been used in the treatment of dermatofibromas. [135, 136] A combination of Q-switched Alexandrite and V-beam pulsed-dye lasers were used successfully in a series of patients. [137]

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Long-Term Monitoring

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.

Patients with one of the aggressive subtypes or histologic perineural invasion should be seen periodically to rule out evidence of recurrence. [129]

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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