Dermatofibroma: what you need to know about this benign tumor

In the wide world of cutaneous lesions, the dermatofibroma stands out as a benign skin lesion, which nevertheless can frighten many patients. Although it is not dangerous, its presence and rapid onset can generate doubts and concerns, even if it is thought to be a malignant lesion. This article is designed to clear all your doubts about dermatofibromas, explaining in detail what they are, why they appear and when it is necessary to seek treatment. 

A patient in a minimalist dermatology consultation room, concerned about a lesion on his leg. The patient is seated on the examination table, while the dermatologist examines the lesion, which could be a dermatofibroma. The room is clean and modern, with white walls, a sleek desk and a few medical instruments. The atmosphere is professional but reassuring.

What will I talk about in this article?

What is a dermatofibroma?

Dermatofibroma, also known as fibrous histiocytoma, is a benign soft and fibrous tissue tumor that develops in the skin. They usually present as small, firm, small papules, generally less than 1 cm in diameter. These nodules are more common on the extremities, but can appear anywhere on the body.

image obtained from https://dermoscopedia.org/03-Dermatofibroma

Causes and Risk Factors

The exact cause of dermatofibroma remains unknown. However, an association with previous skin trauma, such as insect bites, minor wounds or superficial punctures, has been observed. Often, patients report having suffered some type of lesion in the area where the dermatofibroma appears.

Who gets dermatofibromas?

Dermatofibroma can affect people of all ages, but it can also affect people with is more common in individuals between 20 and 50 years of age, and has a higher prevalence in women. Studies have shown that these tumors constitute approximately 3% of all dermatopathology specimens sent to laboratories.

Why do dermatofibromas appear?

The exact cause of dermatofibroma is not known with certainty. However, it is believed to be a reactive response to minor skin trauma, such as insect bites, scratches or superficial punctures.. Although, in many cases, these lesions appear without any apparent triggering event. It is likely that both inflammatory and neoplastic reactive factors play a role in their development.

Symptoms of dermatofibromas

Most dermatofibromas are asymptomatic and are discovered incidentally. However, some may cause pain, tenderness or itching. They usually present as firm nodules that are brown, red or yellow to the touch, and may retract when compressed laterally, a phenomenon known as the "dimple sign".

Image of a dermatofibroma on the skin of a leg, showing the 'dimple sign'. When lateral pressure is applied around the lesion, a central depression is seen in the nodule, a distinctive feature of dermatofibroma.
image obtained from https://www.eumedicoresidente.com.br/post/dermatofibroma
The "dimple sign" is a distinctive clinical feature of dermatofibroma. It is seen when lateral pressure is applied around the lesion, causing a central depression or "dimple" in the center of the nodule. This occurs because the dermatofibroma is firmly attached to the underlying layers of the skin, and lateral pressure causes the central part of the lesion to collapse. This sign is useful in differentiating dermatofibromas from other types of skin lesions.

Diagnosis

The diagnosis of dermatofibroma is generally is performed by clinical examination, patient history and using dermoscopy. In doubtful cases, a biopsy can be performed to confirm the diagnosis. Below is a typical dermatoscopic image of a dermatofibroma. 

Dermatologist holding a dermatoscope

Treatment

In the majority of cases, dermatofibromas do not require treatment, as they are benign and do not represent a significant health risk. However, if they cause discomfort or for cosmetic reasons, the following treatment options may be considered:

  • Surgical excisionComplete removal of the nodule may be necessary if there is suspicion of malignancy or if the patient desires it for cosmetic reasons. It is the treatment of choice in most cases.
  • CryotherapyCryotherapy has been described in some cases for the treatment of dermatofibromas, although in my opinion it is not very useful and does not have good results.

Can dermatofibromas be prevented?

Although dermatofibromas cannot be prevented, it is important to educate patients about the benignity of these tumors and that in most cases they will not require further treatment. We always advise patients to watch for any changes in their skin lesions and that consult a dermatologist if you notice anything unusual, as it could be a malignant lesion..

Conclusion

Dermatofibroma is a common benign lesion that can appear anywhere on the body, especially on the extremities. Although generally harmless, it can cause discomfort and cosmetic concerns in some cases. Diagnosis is usually clinical, supported by biopsy if necessary, and treatment is reserved for symptomatic cases or by patient preference. Patient education is critical to ensure proper understanding and management of these lesions.

References

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Sebastian Podlipnik - Skin cancer

Sebastian Podlipnik

Dermatology Blog

I am a dermatologist and cum laude MD and author of multiple research studies. I specialize in skin cancer, laser technologies and cosmetic dermatology. The intention of this blog is to bring you closer to topics of interest in dermatology and research.

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