Melanoma ?

A 52-year-old woman consulted for an atypical pigmented lesion on her right thigh.

Dermoscopy revealed:

• asymmetry
• eccentric pigmentation
• atypical reticular network
• depigmentation
• pink/red area

Clinical and dermoscopic images were in favor of a melanoma.

Lesion was excised and pathology revealed a dermatofibroma.

This case is interesting to show how a dermatofibroma may be atypical:

• clinical examination: no induration at palpation and asymmetry of colours
• dermoscopic features

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

Dermatofibroma

A 32-year-old woman consulted for this firm pigmented lesion on her left calf.

Dermoscopy revealed a pigmented network with multiple scar-like patches.
Typically the dermoscopic presentation of dermatofibromas consist in a central white scar-like patch with peripheral delicate pigment network. In this case the scar-like depigmentation was in patches and in a asymmetric disposition.

Zaballos et al * found multiple scarlike patches in 12.3% of dermatofibromas with
a scarlike patch and note that Blum and Bauer described a case of melanoma dermoscopically
mimicking a dermatofibroma with 4 central white scarlike patches and a delicate pigment network at the periphery.
* Arch Dermatol. 2008;144(1):75-83

Dermatofibroma with vascular structures

A 54-year-old woman consulted for a firm reddish tumor on her left thigh.
Dermoscopy revealed a central scarlike white patch in favor of a dermatofibroma and peripheral vascular structures: peripheral erythema and linear-irregular vessels.

peripheral erythema and linear-irregular vessels

Vascular structures are found in 29 to 49% of dermatofibromas, including erythema, dotted vessels, coma vessels, hairpin vessels, glomerular vessels, telangiectasias, linear-irregular vessels, polymorphous/atypical vessels.

Litterature:
Dermoscopy of dermatofibromas. A Prospective Morphological Study of 412 Cases
P. Zaballos, S. Puig, A. Llambrich, J. Malvehy, Arch Dermatol. 2008;144(1):75-83

Peripheral reticular pigmentation

In this case of dermatofibroma, we can see a central white patch with a delicate peripheral pigment network. In the former case of dermatofibroma, the pigmentation was not reticulated.

Dermatofibroma, actinic lentigo and flat seborrheic keratosis are the only non-melanocytic lesions which display a pigment network.

Other cases of dermatofibromas
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Dermatofibroma

Typical assciation of a central white patch with a peripheral pigmentation (not reticulated ) in a dermatofibroma

Other cases of dermatofibromas
1 2 3 4 5 6 7 8 9 10 11 12 13

Blue nevus

Typical blue homogeneous pattern* in favour of a blue nevus.

* synonym: blue structure less pattern

Dermatofibroma.

A 27-year-old woman consulted for a pigmented lesion on her right shoulder.
Dermoscopy revealed multiple white scarlike patches, globule-like structures, and a delicate peripheral pigment network, in favor of a dermatofibroma.


Globule-like structures well seen on this picture (magnification X70).

Other cases of dermatofibromas
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Unusual localization of a dermatofibroma

A 53-year-old man consulted for this firm tumor on his 5th left finger. Clinical diagnoses were an acquired fibrokeratoma or a wart.


Dermoscopy revealed a peripheral homogeneous pigmentation and a
central white scarlike patch in favor of a dermatofibroma.

The lesion was excised and pathology confirmed this diagnosis of dermatofibroma.

Dermatofibromas are usually localized on the extremities , shoulders, thighs, buttocks.
Digital localization is rarely reported in the literature*.
Dermoscopy allows a more accurate diagnosis before excision of digital tumors.

* T. Yamamoto et al. Dermatofibroma of the digit: report of six cases.Dermatology 2003; 207:79-81

Other cases of dermatofibromas
1 2 3 4 5 6 7 8 9 10 11 12

Dermatofibroma

A 65-year-old man consulted for firm pigmented lesion on his right leg.


Dermoscopy featured:

• a central white scarlike patch
• a peripheral pigment network
• ring-like structures

in favor of a dermatofibroma.



Other cases of dermatofibromas
1 2 3 4 5 6 7 8 9 10 11 12

Globule-like structures and ring-like structures

A 45-year-old man consulted for a pigmented firm tumor on his right shoulder.
Firm aspect on palpation and dermoscopic feature were in favor of a dermatofibroma.


Brown globule-like structures and ring-like structures (red circle) were observed.

Globulelike structures are formed because the rete ridges are often flat, confluent, and hyperpigmented .
Ringlike structures are a kind of globule with a darker peripheral rim.

Fissures and ridges were also displayed in this case (arrows)

The most frequent dermoscopic patterns observed in dermatofibromas are the central white
scar- like patch and the peripheral delicate pigment network.
Globule-like structures, ring-like structures, fissures and ridges are less usual structures in this kind of tumor.


Recent litterature about dermoscopy of dermatofibromas:
Pedro Zaballos, Susana Puig, Alex Llambrich, Josep Malvehy. Dermoscopy of Dermatofibromas. A Prospective Morphological Study of 412 Cases. Arch Dermatol. 2008;144(1):75-83

Other cases of dermatofibromas
1 2 3 4 5 6 7 8 9 10 11 12

Dermatofibroma

A 36-year-old woman consulted for this firm tumor on her right thigh. Dermoscopy revealed a central white scar-like patch and a delicate light brown network.
The lesion was excised and pathology revealed a dermatofibroma.



Other cases of dermatofibromas
1 2 3 4 5 6 7 8 9 10 11 12

Dermatofibroma

A 35-year-old woman consulted for a painful firm pigmented tumor clinically in favor of a dermatofibroma.



Dermoscopy revealed a central white scar-like patch surrounded by a pigmented network and many brown globules.




Dermatofibromas have various dermoscopic features.

For more information:

Isil Kilinc Karaarslan et al. Different dermoscopic faces of dermatofibromas. J Am Acad Dermatol 2007;57:401-6

Other cases of dermatofibromas
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Dermatofibroma

A 59-year-old patient consulted for a hard lesion on her left leg. The clinical diagnosis of dermatofibroma was suspected.



Dermoscopy confirmed easily the diagnosis of dermatofibroma (or histiocytoma) showing a central white patch and a delicate light brown fine network.

Other cases of dermatofibromas
1 2 3 4 5 6 7 8 9 10 11 12

Dermatofibroma

This firm tumor on the left leg of a 34-year-old woman is typical of dermatofibroma in dermoscopy with a central white patch and a delicate light-brown pigment network at the peripheryThis firm tumor on the left leg of a 34-year-old woman is typical of dermatofibroma in dermoscopy with a central white patch and a delicate light-brown pigment network at the periphery

Other cases of dermatofibromas
1 2 3 4 5 6 7 8 9 10 11 12

Central white patch

This is classic case of dermatofibroma with a central white patch with a reticular depigmentation and a fine pigment network at the periphery

Other cases of dermatofibromas
1 2 3 4 5 6 7 8 9 10 11 12

Dermatofibroma

This woman presented a dermatofibroma on her lower right leg confirmed by a biopsy.
The dermoscopy showed a vascular pattern (*) with a rim of hairpin vessels.
The central white patch was less remarkable than in other cases of dermatofibromas.
Dotted vascular pattern or atypical vascular pattern in dermatofibromas have been reported in the literature (Ferrari et al , Acta Derm Venereol 2004, 84: 164-165)

Atypical dermatofibroma with vascular pattern

A 68-year-old man consulted for this lesion on his right leg present for more than 15 years.
Dermoscopy revealed some light brown globules (*) and a vascular pattern with polymorphous vessels: hairpin vessels, dotted vessels, and linear-irregular vessels.
A biopsy was performed and revealed a dermatofibroma.
Dermatofibromas with vascular pattern have been reported in the literature (D.Picolo, K.Peris, page 287, in color atlas of melanocytic lesions of the skin, Springer edition, 2007)

Dermatofibroma

A 30-year-old woman consulted for this pigmented lesion on her right leg.
Dermoscopy revealed a central white scar-like patch surrounded by a delicate pigmented network, in favor of a dermatofibroma.

Dermatofibroma

A 52-year-old man consulted for a painful, firm light-brown plaque of her right leg


Dermatoscopy: x20
central white patch and delicate pigment network at the periphery are typical dermoscopic signs of dermatofibroma


























Other cases of dermatofibromas
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