Dermatofibromas

From dermoscopedia

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Dermatofibromas (DFs) are prevalent cutaneous lesions that most frequently affect young to middle-aged adults, with a slight predominance in females. Clinically, dermatofibromas appear as firm, single or multiple papules/nodules with a relatively smooth surface and predilection for the lower extremities. Characteristically, upon lateral compression of the skin surrounding dermatofibromas, the tumors tend to pucker inward producing a dimple-like depression in the overlying skin; a feature known as the dimple or Fitzpatrick’s sign.

Dermoscopy features: [1][2][edit]

Classic dermoscopic features:[edit]

  • Delicate pigment network: light-to-medium pigment network, brown in color, with a fine and delicate quality, which gradually fades into the surrounding skin and is usually located at the periphery of the lesion.
  • A central scar-like white patch: an irregularly outlined and sharply demarcated white area in the center of the lesion. In nonpolarized light dermoscopy appears as a white scar-like area and in polarized light dermoscopy as bright white areas with or without bright white linear streaks (Shiny white lines).

Additional dermoscopic features:[edit]

  • Ring-like or donut-shaped globules: The pigment network located toward the center of the lesion often ceases to look like a reticulated mesh but rather begins to resemble “ring-like” globular structures
  • White network : white lines surrounding small islands of brown pigment or surrounding globule-like (i.e., “ring-like”) structures.
  • Homogenous areas with brown color.
  • Vascular structures: The most common vascular structures are erythema, dotted vessels, comma vessels, and hairpin vessels. Less frequently, glomerular vessels, linear–irregular vessels, linear vessels in a radial arrangement, and polymorphous/atypical vessels are visible.
  • Rarely comedo-like openings, scale, ulceration, peripheral collarette fissures, ridges and mamillatted surface.

Dermoscopy patterns[3][4]:[edit]

The different dermoscopic features of dermatofibroma are combined into ten different typical dermoscopic patterns and one atypical pattern.

Typical dermoscopic patterns:[edit]

  • Peripheral delicate pigment network and central white scar-like patch - This "stereotypical" dermoscopic pattern is seen in most cases of dermatofibroma and has been reported in 18-35% of DFs.
8 5 DF FIGURE 1.jpg



  • Delicate pigment network throughout - 3-15% of DFs.
8 5 DF FIGURE 3.JPG




  • Peripheral delicate pigment network and central white network - 5-9% of DFs.
8 5 DF FIGURE 2.jpg



  • Peripheral delicate pigment network and central homogenous pigmentation - 4-5% of DFs.


  • White network throughout - 2% of DFs.
8 5 DF FIGURE 4.jpg



  • Homogenous pigmentation throughout - 5-11% of DFs.


  • White scar-like patch throught- 4-6% of DFs.


  • Multiple focal white scar-like patches - 6-8% of DFs.


  • Peripheral homogenous pigmentation and central white scar-like patch - 7-8% of DFs.


  • Peripheral homogenous pigmentation and central white network - 5-8% of DFs.


Atypical dermoscopic patterns:[edit]

Dermatofibromas showing atypical pigment network, atypical scar-like patch, atypical homogeneous pigmentation or their irregular distribution within the lesion. The atypical pattern can be further subdevided into: (1) 'Melanoma-like'; (2) 'vascular tumor-lie'; (3) 'basal cell carcinoma-like'; (4) 'collision tumor-like'; (5) 'psoriasis-like'.

8 5 DF FIGURE 5.jpg

Dermatofibroma variants:[edit]

Hemosiderotic or aneurysmal dermatofibroma:[edit]

Hemosiderotic or aneurysmal dermatofibroma usually manifests with a multi-component or atypical dermoscopic pattern with central bluish/reddish homogenous areas in combination with white structures, peripheral delicate pigment network, and vascular structures. Sometimes, blue homogeneous pigmentation throughout is observed.

8 5 DF FIGURE 6.jpg



Lipidized dermatofibroma:[edit]

Lipidized dermatofibroma usually manifests with the presence of single/multiple foci of yellow coloration/pigment.




References:



  1. Zaballos et al.: Dermoscopy of dermatofibromas: a prospective morphological study of 412 cases. Arch Dermatol 2008;144:75-83. PMID: 18209171. DOI.
  2. Ferrari et al.: Typical and atypical dermoscopic presentations of dermatofibroma. J Eur Acad Dermatol Venereol 2013;27:1375-80. PMID: 23176079. DOI.
  3. Zaballos et al.: Dermoscopy of dermatofibromas: a prospective morphological study of 412 cases. Arch Dermatol 2008;144:75-83. PMID: 18209171. DOI.
  4. Ferrari et al.: Typical and atypical dermoscopic presentations of dermatofibroma. J Eur Acad Dermatol Venereol 2013;27:1375-80. PMID: 23176079. DOI.