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Sections Dermatofibroma
- Overview
- Presentation
- DDx
- Workup
- Treatment
- Questions & Answers
- Media Gallery
- References
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.
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]
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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Erythematous, slightly hyperpigmented nodule on the leg. Courtesy of David Barnette, MD.
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Acanthotic epithelium with basilar hyperpigmentation (dirty feet) over a dermal spindle cell proliferation (X10). Courtesy of David Barnette, MD.
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Collagen trapping by the dermal fibrohistiocytic infiltrate (X40). Courtesy of David Barnette, MD.
Tables
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.
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.
David F Butler, MD Former 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: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society
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.
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.
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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