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DERMATOFIBROMAS

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Related Term: Fibrous Histiocytoma

Clinical:

Dermatofibromas are small pea size nodules (benign) noncancercous growths that occur on either the skin of legs or on the arms. They range in color from yellow-brown to dark red or reddish brown. These growths are benign and are usually painless. Composition is of  spindle cells or histiocytes in association with collagen.  Generally these growths appear singularly. However they may appear in clumps and the pattern of distribution may be irregular.

There is no correlation to suggest that lymphedema leads to or causes dermatofibromas, but due to the fact we continously have questions regarding them, I felt it helpful to include a page of basic information.  In addition, there are significant vascular, blood flow and lymphatic changes that occur in lymphedema and as such, I do have questions on whether or not it causes us to be more susceptible various skin complications. 

Etiology:  

Generally unknown

Causes: 

Can include trauma (injury), insect bites, and cuts caused by shaving.

Symptoms:

Dermatofibromas usually develop slowly and usually appear on the lower legs. These small, hard, raised skin growths can have various characteristics: (1)

Diagnosis:

Diagnosis is usually made by simple examination.  however, if there is any question or if the dermatofibroma is rapidly growing a biopsy may be performed.

Treatment:

Because these lesions are harmless and not associated with pain or infections generally they are not treated, unless for cosmetic appearances. In this case they can be surgical removed,  tangential excised or removed by cryosurgery (freezing).

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Dermatofibromas

Dermatofibroma (DF) is a common cutaneous nodule of unknown etiology. It can occur anywhere, but seems to favor exposed areas. Dermatofibromas feel like hard lumps under the skin. Dermatofibromas occur most often in women. A dermatofibroma is also sometimes called a fibrous histiocytoma. Typical dermatofibromas cause little or no discomfort, although itching and tenderness can occur. They are firm and often feel like a stone under the skin. They may be skin coloured or brown to brown-blue in colour. Dermatofibroma are common spots found frequently on the legs, but may occur on other sites such as the arms and trunk. Dermatofibromas are best ignored. If the diagnosis is uncertain, a piece may be removed for tissue analysis. However, treatment of dermatofibromas is usually not necessary unless they are causing you some discomfort or you feel they are unattractive.

Dermatofibroma is basically a skin disease typical to youth, but dermatofibroma may occur to the people at any age. Dermatofibromas are quite common, and occur more often in women over the age of 17. The cause of dermatofibromas is unknown. They are usually single but sometimes may be multiple. Simple excision is curative. Physicians recommend a treatment only when the lesion comes in the way of shaving or becomes irritated by clothing. Dermatofibroma can be removed surgically with the help of local anesthesia. It can be flattened by using liquid nitrogen. Liquid nitrogen is used to freeze it and flatten it. Liquid nitrogen destroys only the upper part of the growth and it may become noticeable after a few years. Another freezing can be done to handle the problem later.

Causes of Dermatofibroma

The exact cause of dermatofibroma is not known but in some cases it may be caused by insect bites, minor injury or thorn pricks. Dermatofibroma may also be caused by genetic factors. It mostly occurs in women. They are usually single but sometimes may be multiple. Simple excision is curative. Dermatofibromas seem to be caused by some sort of injury, such as a bump, bug bite, or cut.

Common causes and risk factors of Dermatofibroma:

Signs and Symptoms of Dermatofibroma

Dermatofibromas most often occur on the legs and arms. Once developed, they usually persist for years. Dermatofibromas feel like hard lumps under the skin. They probably are a reaction to a minor injury, such a bug bite or a splinter. Dermatofibromas are like an iceberg in that there is more under the skin than seen on the surface. Dermatofibroma can occur at any age but generally it develops in young adulthood. Around twenty percent of the lesions occur before the age of seventeen. The nodule feels like tiny pebble or a small pea that is fixed to the skin.

Sign and symptoms may include the following :

Treatment for Dermatofibroma

A dermatofibroma is of cosmetic significance only and although it tends to persist long term, it seldom causes any symptoms. Usually only reassurance is needed. Physicians recommend a treatment only when the lesion comes in the way of shaving or becomes irritated by clothing. Dermatofibroma can be removed surgically with the help of local anesthesia. As it grows much more beneath the surface than on the surface so the scar may be larger than the actual tumor.

Treatment may include:

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Multiple dermatofibromas on face treated with carbon dioxide laser: The importance of laser parameters

2008


 Department of Dermatology and STD, Maulana Azad Medical College, New Delhi, India

Correspondence Address:
Sardana Kabir
Sect. 28, 466, Noida - 201 303, UP
India

Sir,

Dermatofibroma (DF) is one of the common dermatologic diseases treated by practicing dermatologists. [1] The use of carbon dioxide laser has emerged as an effective option for treatment of numerous epidermal and dermal dermatological lesions, including benign and malignant growths, keloids, vascular deformities, warts and tattoos. [2] The focus has now shifted from continuous wave (CW) to super-pulse (SP) and now ultrapulse (UP) mode. [3] The latter mode combines efficacy and minimal tissue damage and is preferred by most laser surgeons worldwide. [3]

The case published [4] highlights two concepts. One the use of CO 2 laser, and second its apparent beneficial effects on fibrosis. But surprisingly, no mention is made of some standard facts that are mandatory in laser article publications worldwide: [3] the type of laser, the make, the mode used (CW, SP, UP), the sub-mode used (continuous, repeat, pulsed), the energy used (joules/cm 2 ) and in most pulsed surgery - the total power (W), power/pulse (mJ), pulse width (in µs), frequency (Hz) and pulse diameter. [3]

Nowadays, it is routine to use a two-step procedure, first to debulk the tissue with CW mode and then to destroy the base with UP mode, with the end-point varying depending on the lesion to be treated. [3] This use of UP mode ensures better cosmesis. [3] Notwithstanding the high recurrence that is the norm in similar conditions with fibroblastic proliferation like keloids, [3] it is heartening to note the decent results obtained by the authors. [4] But, we were surprised to note that no mention was made of a previous study on 18 patients (20 lesions) with PDL where 15 of 20 lesions (75%) responded. [5] With so little on the subject, a proper perspective was warranted in the article on whether PDL is superior to CO 2 or not.

Indian Journal of Dermatology, Venereology and Leprology

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Mycosis fungoides exhibiting features of a dermatofibroma: a case report and review of the literature.  

Nov 2011

Morcos SM, Girardi M, Subtil A, Wilson LD, Cowper SE.

Source

Department of Dermatology, Yale University School of Medicine, New Haven, CT, USA Department of Pathology, Yale University School of Medicine, New Haven, CT, USA Department of Dermatology, Yale University School of Medicine, New Haven, CT, USA Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA.

Abstract

We present the case of a 60-year-old male with known stage IA mycosis fungoides (MF) who developed a suspicious tumor within a pre-existing lymphomatous plaque of the right forearm. Microscopy revealed an unusual mixed fibrohistiocytic proliferation as well as atypical intraepidermal and dermal lymphocytes. There was no evidence of large-cell transformation. Histopathological, immunohistochemical and clinical clues suggest this lesion might not have represented adermatofibroma, but rather a hitherto unreported dermatofibroma-like process arising within a lesion of MF. The potential impact of this atypical lesion on the prognosis and clinical management of this patient highlights the importance of recognizing unusual clinical presentations of more common, benign lesions within this patient population. Morcos SM, Girardi M, Subtil A, Wilson LD, Cowper SE. Mycosis fungoides exhibiting features of a dermatofibroma: a case report and review of the literature. 

Wiley Online

http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0560.2011.01804.x/abstract

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Subcutaneous dermatofibroma

May 2011

Source

Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

Dermatofibroma (DF) is usually confined to the dermis and the overlying epidermis is usually hyperplastic. Although DF with deep subcutaneous extension is commonly encountered, purely subcutaneous DF is uncommon. In this review, we describe a case of a 41-year-old male patient who presented with a painless, subcutaneous, hard papule on the left thigh. After the skin had been incised the lesion was totally removed, and histopathology revealed a subcutaneous dermatofibroma.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3130878/?tool=pubmed

Clinical Studies and Abstracts

Hemangiopericytoma-like dermatofibroma with mast cells. Aug 2011

http://journals.lww.com/amjdermatopathology/pages/articleviewer.aspx?year=2011&issue=08000&article=00029&type=abstract

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The expression levels of thrombospondin-1 in dermatofibroma and dermatofibrosarcoma protuberans. Jul-Aug 2011 

John Libbey Eurotext

http://www.jle.com/en/revues/medecine/ejd/e-docs/00/04/6C/06/resume.phtml

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IGFBP7, a novel immunohistochemical marker in differentiating dermatofibroma from dermatofibrosarcoma protuberans. Apr 2011 

Wiley Online

http://onlinelibrary.wiley.com/doi/10.1111/j.1468-3083.2011.04072.x/abstract

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Giant hemosiderotic dermatofibroma: a case report and review of the literature. Feb 2011

PubMed

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3073750/?tool=pubmed

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Mitosis in dermatofibroma: a worrisome histopathologic sign that does not necessarily equal recurrence.

J Cutan Pathol. 2008 Mar 10

Blackwell Synergy

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Dermoscopy of dermatofibromas: a prospective morphological study of 412 cases.

Arch Dermatol. 2008 Jan

Archives of Dermatology

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Proliferation of HSP47-positive skin fibroblasts in dermatofibroma.

Cutan Pathol. 2008 Jan

Wiley Online

http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0560.2007.00768.x/abstract;jsessionid=A256D2CF77000ABDF71241AC39EA2C2A.d01t01

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Multiple eruptive dermatofibromas in 2 patients infected with the human immunodeficiency virus

Actas Dermosifiliogr. 2007 Dec

http://www.ncbi.nlm.nih.gov/pubmed?term=Multiple%20eruptive%20dermatofibromas%20in%202%20patients%20infected%20with%20the%20human%20immunodeficiency%

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External Links

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Dermatofibromas

http://www.merckmanuals.com/home/skin_disorders/noncancerous_skin_growths/dermatofibromas.html?qt=dermatofibroma&alt=sh

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Dermatofibroma

eMedicine

http://www.emedicine.com/DERM/topic96.htm

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Dermatofibroma

http://www.hmc.psu.edu/healthinfo/d/dermatofibroma.htm

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Dermatofibromas (1)

Harvard School of Medicine

http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/9813.html br /

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Dermatofibromas

http://www.bad.org.uk/site/809/default.aspx

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Dermatofibromas

http://www.dermnetnz.org/lesions/dermatofibroma.html

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Diagnostic Images

Dermatofibroma: Dermatofibromas are benign, firm nodules, usually smaller than a pea, which occur most commonly on the legs or back. Women are affected more often than men. They sometimes will follow an insect bite or other minor trauma, and may represent a scar-tissue reaction rather than a true growth. Dermatofibromas are usually solitary, only slightly elevated above the skin, and may be pink, brown, even multicolored. They often appear suddenly, reach their largest size over a few weeks, and then persist. Rarely, they will regress spontaneously. Treatment is not necessary, but they can be removed for cosmetic reasons using the CO2 laser, cautery, or direct excision and closure. There have been reports of successful treatment using the pulsed dye laser. Recurrence after treatment is uncommon.

See also: 

DermNet

http://www.dermnetnz.org/lesions/dermatofibroma.html

Google

http://images.google.com/images?gbv=2&hl=en&q=dermatofibromas&btnG=Search+Images

Yahoo

http://images.search.yahoo.com/search/images?p=dermatofibromas&fr=yfp-t-501&toggle=1&cop=mss&ei=UTF-8

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ICD-10

023 

Other benign neoplasms of skin
023 Includes: benign neoplasm of:
· hair follicles
· sebaceous glands
· sweat glands
Excludes: benign lipomatous neoplasms ( D17.0-D17.3 )
melanocytic naevi ( D22.- )
D23.0 Skin of lip
Excludes: vermilion border of lip ( D10.0 )
D23.1 Skin of eyelid, including canthus
D23.2 Skin of ear and external auricular canal
D23.3 Skin of other and unspecified parts of face
D23.4 Skin of scalp and neck
D23.5 Skin of trunk
Anal:
· margin
· skin
Perianal skin
Skin of breast
Excludes: anus NOS ( D12.9 )
skin of genital organs ( D28-D29 )
D23.6 Skin of upper limb, including shoulder
D23.7 Skin of lower limb, including hip
D23.9 Skin, unspecified

ICD-9

2008 ICD-9-CM Diagnosis 216.9

Benign neoplasm of skin site unspecified

  • 216.9 is a specific code that can be used to specify a diagnosis
  • 216.9 contains 1 index entry
  • View the ICD-9-CM Volume 1 216.* hierarchy

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Lymphedema People - Support Groups

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Children with Lymphedema

The time has come for families, parents, caregivers to have a support group of their own. Support group for parents, families and caregivers of chilren with lymphedema. Sharing information on coping, diagnosis, treatment and prognosis. Sponsored by Lymphedema People.

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Lipedema Lipodema Lipoedema

No matter how you spell it, this is another very little understood and totally frustrating conditions out there. This will be a support group for those suffering with lipedema/lipodema. A place for information, sharing experiences, exploring treatment options and coping.

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Support group for parents, patients, children who suffer from all forms of lymphangiectasia. This condition is caused by dilation of the lymphatics. It can affect the intestinal tract, lungs and other critical body areas.

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Lymphatic Disorders Support Group @ Yahoo Groups

While we have a number of support groups for lymphedema... there is nothing out there for other lymphatic disorders. Because we have one of the most comprehensive information sites on all lymphatic disorders, I thought perhaps, it is time that one be offered.

DISCRIPTION

Information and support for rare and unusual disorders affecting the lymph system. Includes lymphangiomas, lymphatic malformations, telangiectasia, hennekam's syndrome, distichiasis, Figueroa
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Have you seen our new “Wiki” pages yet?  Listed below are just a sample of the more than 140 pages now listed in our Wiki section. We are also working on hundred more.  Come and take a stroll! 

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Infections Associated with Lymphedema 

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How to Treat a Lymphedema Wound 

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Fungal Infections Associated with Lymphedema 

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Lymphedema in Children 

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Lymphoscintigraphy 

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Extraperitoneal para-aortic lymph node dissection (EPLND) 

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