Atypical dermatofibroma

A 27-year-old woman consulted for a red firm lesion on her right cheek. This lesion was present for 1 year.

Picture 1: slight pressure of the dermoscope

Dermoscopy revealed a dotted vascular pattern (dotted vessels) as the only dermoscopic sign.
Clinical diagnoses were Spitz nevus, hypopigmented Clark nevus and amelanotic melanoma. Dotted vessels are typically reported in these 3 cutaneous tumors.

The lesion was excised and pathology revealed a dermatofibroma.

Picture 2: more pressure of the dermoscope

Similar cases of dermatofibroma with a dotted vascular pattern are rarely reported in the literature (1- 2 - 3)

Dermatofibromas are rare on the face. Cases of of dermatofibromas of the face have to be excised with wider margins in comparison with examples of classical dermatofibromas occuring on the extremities because of diffuse infiltration, involvement of deeper structures and a increased rate of local recurrences (4)


References:

1 - Color atlas of melanocytic lesions of the skin. Soyer et al. Ed Springer. Chapter V.2: Piccolo and Peris: page 287

2 - Pedro Zaballos et al. Dermoscopy of Dermatofibromas. A Prospective Morphological Study of 412 CasesArch Dermatol. 2008;144(1):75-83

3 - Ferrari A et al. Cutaneous amelanotic melanoma metastasis and dermatofibromas showing a dotted vascular pattern. Acta Derm Venereol. 2004;84(2):164-165.

4 - Mentzel et al. Benign fibrous histicocytoma (dermatofibroma) of the face. Clinicopathologic and immunohistochemical study of 34 cases associated with an aggressive clinical course. Am J Dermatopathol 2001; 23(5): 419 -26