, Corinna Eleni Psomadakis2 and Bobby Buka3
Department of Family Medicine, Mount Sinai School of Medicine Attending Mount Sinai Doctors/Beth Israel Medical Group-Williamsburg, Brooklyn, NY, USA
School of Medicine Imperial College London, London, UK
Department of Dermatology, Mount Sinai School of Medicine, New York, NY, USA
KeywordsDermatofibromaBenignGrowthLesionHistiocytomaFibrous tissueCryosurgeryExcisionLegLower limbBumpLumpNodule
Occasionally there is precursor nominal trauma (like a bug bite) described, but usually these dermal lesions appear spontaneously
Button-like firm dermal papule, asymptomatic
Primary Care Visit Report
A 26-year-old female smoker presented with a “lump ” on her right upper arm. She said it had been there for a few years and was unchanged until recently, when she noticed a “white thing on it.” The patient wanted to have it removed.
Vitals were normal. On exam, there was a non-tender 4 mm hyperpigmented papule on her right upper arm with central white dome.
Unsure what this was, I referred the patient to dermatology. However, the patient did not want to pay the higher co-pay to go to a specialist and opted to leave the lesion alone.
Discussion from Dermatology Clinic
Foreign body granuloma
The lesion has been present for a few years without change, which suggests it is benign . The growth is small, firm, and located on an extremity, all of which are features of dermatofibromas.
Dermatofibromas, also called histiocytomas , are benign dermal nodules that usually appear in the extremities. Dermatofibroma is a common skin lesion, accounting for 3 % of skin lesion specimens received by one laboratory . Most cases occur in the third through fifth decades of life and show female predominance . It represents a benign process with no malignant potential. Dermatofibroma may be associated with history of local trauma. Multiple eruptive dermatofibromas have been noted in patients with systemic lupus erythematosus and HIV . It is unknown whether dermatofibromas are a true neoplasm versus an inflammatory response, and there are several histologic variants of the lesions [1, 2].