II. Epidemiology
- Males predominate (3:1 ratio)
- Age of onset 20-50 years old
III. Pathophysiology
- Idiopathic, benign, fibroblast proliferation within the skin
IV. Causes
- Idiopathic benign skin tumor
- Fibrous reaction to local irritation
- Local Trauma
- Insect Bite
- Viral Infection
- Folliculitis
- Ruptured cysts
- Underlying condition (>15 Dermatofibromas)
V. Symptoms
- Asymptomatic in most cases
- Lesions may be pruritic or tender when irritated
- Persistently pruritic or painful lesions may prompt biopsy
VI. Signs
- Characteristics
- Small firm, raised Papule, Plaque or Nodule (3-10 mm)
- Lesions develop over months and persist for years
- Completely symmetric and regular
- Tan or light brown surface (may be red or yellow)
- Color is darker at center and gradually fades into normal Skin Color
- Fitzpatrick's Sign
- Skin dimples downward when compression is applied to lateral margin
- Pinching lesion between fingers may best demonstrate dimpling
- Distribution
- Most common: Anterior thighs and Legs
- Moderately common: Arms and Trunk
- Uncommon: Head, Palms, and Soles
- Variants
- Multiple eruptive lesions
- Seen in 0.3% of cases (typically Immunocompromised: HIV, SLE)
- More than 15 Dermatofibromas are otherwise rare aside from this condition
- Dermatofibrosarcoma Protuberans
- Deep invasion with metastases
- Multiple eruptive lesions
VII. Differential Diagnosis
- Primary Malignant Melanoma
- Scar
- Blue Nevus
- Pilar Cyst
- Metastatic Carcinoma
- Kaposi's Sarcoma
VIII. Management
- Excision Indications
- Repeated Trauma with bleeding, irritation
- Unacceptable cosmetic appearance
- Uncertain diagnosis (changes in size, color)
- Techniques
- Eliptical excision or Punch Biopsy
- Risk of scarring
- Preferred for better histology if malignancy or atypical lesions are suspected
- Other methods (incomplete removal)
- Laser ablation (may be preferred)
- Shave Biopsy
- Cryotherapy
- Eliptical excision or Punch Biopsy
IX. References
- Fitzpatrick (1999) Color Atlas Dermatology
- Higgins (2015) Am Fam Physician 92(7): 601-7 [PubMed]
- Wagner (2024) Am Fam Physician 110(4): 353-61 [PubMed]
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Related Studies
| Definition (NCI) | A solitary, slowly growing nodular mass, most often affecting the extremities. It is composed of fibrous and histiocytic cells which infiltrate the dermis and occasionally the underlying subcutaneous tissue. Usually local excision is curative. Recurrences are reported only in a small minority of cases. |
| Definition (MSH) | A slowly growing benign skin nodule consisting of poorly demarcated cellular fibrous tissue enclosing collapsed CAPILLARIES with scattered HEMOSIDERIN-pigmented and lipid MACROPHAGES. They are common, usually about 1 cm in diameter and occur in the DERMIS. (From Stedman, 25th ed; DeVita Jr et al., Cancer: Principles & Practice of Oncology, 3d ed, p1356) |
| Concepts | Neoplastic Process (T191) |
| MSH | D018219 |
| ICD10 | M8832/0 |
| SnomedCT | 427186000, 72079004, 403997008, 448015002, 254753004, 189051001, 302843004, 254750001, 134302009, 403999006 |
| Spanish | dermatofibroma, no clasificado como subtipo en CIE-O, dermatofibroma (anomalía morfológica), dermatofibroma (trastorno), Dermatofibroma, fibroma pleomórfico, fibrosis nodular subepidérmica, histiocitoma cutáneo, fibroma pleomórfico (trastorno), histiocitoma cutáneo (trastorno), xantoma fibroso cutáneo (trastorno), xantoma fibroso cutáneo, angioma esclerosante (anomalía morfológica), angioma esclerosante de la piel (trastorno), angioma esclerosante de la piel, angioma esclerosante, dermatofibroma lenticular, dermatofibroma, histiocitoma fibroso cutáneo (trastorno), histiocitoma fibroso cutáneo, dermatofibroma, no clasificado como subtipo en CIE-O (anomalía morfológica), Hemangioma Esclerosante, Histiocitoma Cutáneo |
| Dutch | dermatofibroom |
| Japanese | 皮膚線維腫, ﾋﾌｾﾝｲｼｭ |
| English | Dermatofibroma NOS, [M]Dermatofibroma NOS, Dermatofibroma (disorder), Dermatofibroma, no ICD-O subtype, dermatofibromas, sclerosing hemangioma, cutaneous histiocytoma, histiocytomas, pleomorphic fibroma, histiocytoma, Pleomorphic fibroma, Pleomorphic fibroma (disorder), Subepidermal nodular fibrosis, Cutaneous histiocytoma (disorder), Fibrous xanthoma of skin (disorder), Dermatofibroma, no International Classification of Diseases for Oncology subtype (morphologic abnormality), Dermatofibroma, no International Classification of Diseases for Oncology subtype, Dermatofibroma, no ICD-O subtype (morphologic abnormality), Dermatofibroma lenticulare, Fibrous histiocytoma of skin, Fibrous xanthoma of skin, Sclerosing angioma, Cutaneous histiocytoma, Fibrous histiocytoma of skin (disorder), Sclerosing angioma (morphologic abnormality), Sclerosing angioma of skin (disorder), Sclerosing angioma of skin, Benign fibrous histiocytoma of skin, Dermatofibroma, NOS, Dermatofibroma (morphologic abnormality), Fibrous Histiocytoma of Skin, Fibrous Histiocytoma of the Skin, Benign Cutaneous Fibrous Histiocytoma, Benign Fibrous Cutaneous Histiocytoma, Benign Fibrous Histiocytoma of Skin, Benign Fibrous Histiocytoma of the Skin, Benign Skin Fibrous Histiocytoma, Cutaneous Fibrous Histiocytoma, Dermatofibroma, Angioma, Sclerosing, Angiomas, Sclerosing, Sclerosing Angioma, Sclerosing Angiomas, Dermatofibromas, Sclerosing Hemangioma, Cutaneous Histiocytomas, Cutaneous Histiocytoma, Hemangioma, Sclerosing, Hemangiomas, Sclerosing, Histiocytoma, Cutaneous, Histiocytomas, Cutaneous, Sclerosing Hemangiomas, dermatofibroma |
| Czech | dermatofibrom, angiom sklerózující, histiocytom kůže, Dermatofibrom |
| Portuguese | Dermatofibroma, Hemangioma Esclerosante, Histiocitoma Cutâneo |
| French | Dermatofibrome, Angiome sclérosant |
| German | Dermatofibrom, Angiom, sklerosierendes, Histiozytom, kutanes, Hämangiom, sklerosierendes |
| Italian | Dermatofibroma |
| Hungarian | Dermatofibroma |
| Norwegian | Kutant histiocytom, Skleroserende hemangiom, Skleroserende angiom, Dermatofibrom |
Ontology: Histiocytoma, Benign Fibrous (C0206644)
| Definition (NCI_CDISC) | A benign neoplasm composed of a fibroblastic and a histiocytic component. |
| Definition (NCI) | A benign neoplasm composed of fibroblastic spindle cells in a whorled storiform pattern. It is characterized by the presence of foam cells, inflammatory cells, hemosiderin deposition and stromal hemorrhage. |
| Definition (MSH) | A benign tumor composed, wholly or in part, of cells with the morphologic characteristics of HISTIOCYTES and with various fibroblastic components. Fibrous histiocytomas can occur anywhere in the body. When they occur in the skin, they are called dermatofibromas or sclerosing hemangiomas. (From DeVita Jr et al., Cancer: Principles & Practice of Oncology, 5th ed, p1747) |
| Concepts | Neoplastic Process (T191) |
| MSH | D018219 |
| ICD10 | M8830/0 |
| SnomedCT | 189770002, 189769003, 25889007 |
| English | Fibrous Histiocytomas, Histiocytomas, Fibrous, Fibroxanthoma NOS, [M]Fibroxanthoma NOS, [M]Xanthofibroma, Histiocytoma, Benign Fibrous, Fibrous histiocytoma NOS, [M]Fibrous histiocytoma NOS, Histiocytoma, Benign Fibrous [Disease/Finding], benign fibrous histiocytoma, fibrous histiocytoma, xanthofibroma, fibroxanthoma, fibrous histiocytomas, [M]Fibroxanthoma NOS (morphologic abnormality), [M]Fibrous histiocytoma NOS (morphologic abnormality), Fibrous histiocytoma, no ICD subtype (morphologic abnormality), FIBROUS HISTIOCYTOMA, HISTIOCYTOMA, FIBROUS, BENIGN, Fibrous histiocytoma, Fibroxanthoma, Xanthofibroma, Benign fibrous histiocytoma (morphologic abnormality), Benign fibrous histiocytoma, Fibrous histiocytoma, NOS, Fibroxanthoma, NOS, Fibrous Histiocytoma, Histiocytoma, Fibrous, Benign Fibrous Histiocytoma, Benign Fibrous Histiocytomas, Fibrous Histiocytoma, Benign, Fibrous Histiocytomas, Benign, Histiocytomas, Benign Fibrous |
| Japanese | 線維性組織球腫, ｾﾝｲｾｲｿｼｷｷｭｳｼｭ, 皮下線維組織増殖症-結節性, 硬線維腫, 硬化性血管腫, 線維腫-単純性, 皮膚線維腫, 結節性皮下線維組織増殖症, 播種性結節性皮膚線維腫症, 単純性線維腫, 良性線維性組織球腫, 播種性皮膚線維腫症, ｾﾝｲｵｳｼｮｸｼｭ, 線維黄色腫, 血管腫-硬化性, 組織球腫-良性線維性, 線維組織球性腫瘍 |
| Swedish | Histiocytom, benignt fibröst |
| Czech | histiocytom fibrózní, histiocytom benigní fibrózní, Fibrózní histiocytom, Fibroxantom |
| Finnish | Hyvänlaatuinen sidekudoshistiosytooma |
| Russian | ANGIOMA SKLEROZIRUIUSHCHAIA, GISTIOTSITOMA DOBROKACHESTVENNAIA FIBROZNAIA, DERMATOFIBROMA, GISTIOTSITOMA FIBROZNAIA, АНГИОМА СКЛЕРОЗИРУЮЩАЯ, ГИСТИОЦИТОМА ФИБРОЗНАЯ, ДЕРМАТОФИБРОМА, ГИСТИОЦИТОМА ДОБРОКАЧЕСТВЕННАЯ ФИБРОЗНАЯ |
| Italian | Istiocitoma fibroso, Fibroxantoma, Istiocitoma fibroso benigno |
| Spanish | Fibroxantoma, [M]fibroxantoma, SAI (anomalía morfológica), [M]fibroxantoma, SAI, [M]histiocitoma fibroso, SAI, [M]histiocitoma fibroso, SAI (anomalía morfológica), Fibrohistiocitoma, fibroxantoma, histiocitoma fibroso (anomalía morfológica), histiocitoma fibroso, xantofibroma, Histiocitoma fibroso, Histiocitoma Fibroso, Histiocitoma Fibroso Benigno |
| Portuguese | Fibroxantoma, Histiocitoma fibroso, Histiocitoma Fibroso, Histiocitoma Fibroso Benigno |
| Dutch | fibroxanthoom, fibreus histiocytoom, Fibreus histiocytoom, Histiocytoom, fibreus |
| German | Fibroxanthom, fibroeses Histiozytom, Histiozytom, fibröses, Benignes fibröses Histiozytom, Histiozytom, benignes fibröses |
| French | Fibroxanthome, Histiocytome fibreux, Histiocytome fibreux bénin |
| Polish | Histiocytoma włóknista, Guz histocytarny włóknisty, Włókniak skóry, Guz z histiocytów |
| Hungarian | Fibroxanthoma, Fibrosus histiocytoma |
| Norwegian | Benignt fibrøst histiocytom |
Ontology: Sclerosing hemangioma (C1509148)
| Concepts | Neoplastic Process (T191) |
| SnomedCT | 134302009, 72079004 |
| Dutch | hemangioom scleroserend, scleroserend hemangioom |
| French | Hémangiome sclérosant |
| German | Haemangiom, sklerosierend |
| Italian | Emangioma sclerosante |
| Portuguese | Hemangioma esclerosante |
| Spanish | Hemangioma esclerosado, Hemangioma esclerosante, hemangioma esclerosante |
| Japanese | 硬化性血管腫, ｺｳｶｾｲｹｯｶﾝｼｭ |
| Czech | Hemangiom sklerotizující |
| Hungarian | Hegesedő haemangioma, Sclerotisaló haemangioma |
| English | Sclerosing haemangioma, Hemangioma sclerosing, Haemangioma sclerosing, Sclerosing hemangioma |
