II. Epidemiology

  1. Males predominate (3:1 ratio)
  2. Age of onset 20-50 years old

III. Pathophysiology

  1. Idiopathic, benign, fibroblast proliferation

IV. Causes

  1. Idiopathic benign skin tumor
  2. Fibrous reaction to local irritation
    1. Local Trauma
    2. Insect Bite
    3. Viral Infection
    4. Folliculitis
  3. Underlying condition (>15 Dermatofibromas)
    1. Immunocompromised patient
    2. Autoimmune Condition

V. Symptoms

  1. Asymptomatic in most cases
  2. Lesions may be pruritic or tender

VI. Signs

  1. Characteristics
    1. Small firm, raised Papule, Plaque or Nodule (3-10 mm)
    2. Lesions develop over months and persist for years
    3. Completely symmetric and regular
    4. Tan or light brown surface (may be red or yellow)
      1. Color is darker at center and gradually fades into normal Skin Color
    5. Fitzpatrick's Sign
      1. Skin dimples downward with lateral compression
  2. Distribution
    1. Most common: Anterior thighs and Legs
    2. Moderately common: Arms and Trunk
    3. Uncommon: Head, Palms, and Soles
  3. Variants
    1. Multiple eruptive lesions
      1. Seen in 0.3% of cases (typically Immunocompromised: HIV, SLE)
      2. More than 15 Dermatofibromas are otherwise rare aside from this condition
    2. Dermatofibrosarcoma Protuberans
      1. Deep invasion with metastases

VII. Differential Diagnosis

  1. Primary Malignant Melanoma
  2. Scar
  3. Blue Nevus
  4. Pilar Cyst
  5. Metastatic Carcinoma
  6. Kaposi's Sarcoma

VIII. Management

  1. Excision Indications
    1. Repeated Trauma with bleeding, irritation
    2. Unacceptable cosmetic appearance
    3. Uncertain diagnosis (changes in size, color)
  2. Techniques
    1. Eliptical excision or Punch Biopsy
      1. Risk of scarring
    2. Other methods (incomplete removal)
      1. Laser ablation (may be preferred)
      2. Shave Biopsy
      3. Cryotherapy

IX. References

  1. Fitzpatrick (1999) Color Atlas Dermatology
  2. Higgins (2015) Am Fam Physician 92(7): 601-7 [PubMed]

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Ontology: Cutaneous Fibrous Histiocytoma (C0002991)

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