Dermatofibroma physical examination: Difference between revisions

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===Skin===
===Skin===
* Skin examination of patients with dermatofibroma may shows:
* Skin examination of patients with dermatofibroma may show:<ref name="LeeLee2015">{{cite journal|last1=Lee|first1=MiWoo|last2=Lee|first2=WooJin|last3=Jung|first3=JoonMin|last4=Won|first4=ChongHyun|last5=Chang|first5=SungEun|last6=Choi|first6=JeeHo|last7=Moon|first7=KeeChan|title=Clinical and histological patterns of dermatofibroma without gross skin surface change: A comparative study with conventional dermatofibroma|journal=Indian Journal of Dermatology, Venereology, and Leprology|volume=81|issue=3|year=2015|pages=263|issn=0378-6323|doi=10.4103/0378-6323.154795}}</ref><ref name="MentzelWiesner2012">{{cite journal|last1=Mentzel|first1=Thomas|last2=Wiesner|first2=Thomas|last3=Cerroni|first3=Lorenzo|last4=Hantschke|first4=Markus|last5=Kutzner|first5=Heinz|last6=Rütten|first6=Arno|last7=Häberle|first7=Michael|last8=Bisceglia|first8=Michele|last9=Chibon|first9=Frederic|last10=Coindre|first10=Jean-Michel|title=Malignant dermatofibroma: clinicopathological, immunohistochemical, and molecular analysis of seven cases|journal=Modern Pathology|volume=26|issue=2|year=2012|pages=256–267|issn=0893-3952|doi=10.1038/modpathol.2012.157}}</ref><ref name="FitzpatrickGilchrest1977">{{cite journal|last1=Fitzpatrick|first1=Thomas B.|last2=Gilchrest|first2=Barbara A.|title=Dimple Sign to Differentiate Benign from Malignant Pigmented Cutaneous Lesions|journal=New England Journal of Medicine|volume=296|issue=26|year=1977|pages=1518–1518|issn=0028-4793|doi=10.1056/NEJM197706302962610}}</ref><ref>{{Cite journal
*Nodule with 0.3 to 1 cm in diameter
| author = [[Marc Pusztaszeri]], [[Pierre-Yves Jaquet]] & [[Carole Williamson]]
| title = Giant hemosiderotic dermatofibroma: a case report and review of the literature
| journal = [[Case reports in dermatology]]
| volume = 3
| issue = 1
| pages = 32–36
| year = 2011
| month = February
| doi = 10.1159/000324721
| pmid = 21487458
}}</ref><ref>{{Cite journal
| author = [[L. Requena]], [[M. C. Farina]], [[C. Fuente]], [[E. Pique]], [[M. Olivares]], [[L. Martin]] & [[E. Sanchez Yus]]
| title = Giant dermatofibroma. A little-known clinical variant of dermatofibroma
| journal = [[Journal of the American Academy of Dermatology]]
| volume = 30
| issue = 5 Pt 1
| pages = 714–718
| year = 1994
| month = May
| pmid = 8176009
}}</ref>
** Nodule with 0.3 to 1 cm in diameter
*** Note : Gient (> 5 cm) are also reported.
** non-tender nodule
*** Note: Manipulation can cause tenderness
** Hyperpigmentation
** Dimple sign ( lateral compression on the skin makes a depression)
*** Note: Dimple sign can also seen in other skin diseases.
** Puritic nodule ( may happen by superinfection)


*Hyperpigmented
*Dimple sign ( lateral compression on the skin makes a depression)
*Puritic ( may happen by manipulation)
*


*Typically, the clinical appearance of dermatofibroma is a solitary, 0.5- to 1-cm nodule. A sizable minority of patients may have several lesions, but rarely (< 1% of cases) are more than 15 lesions present. (See History) The overlying skin can range from flesh to gray, yellow, orange, pink, red, purple, blue, brown, or black, or a combination of hues (see the image below). On palpation, the hard nodule may feel like a small pebble fixed to the skin surface and is freely movable over the subcutis. Tenderness may be elicited with manipulation of the lesion. The characteristic tethering of the overlying epidermis to the underlying lesion with lateral compression (pinching), called the dimple sign, may be a useful clinical sign for diagnosis. <sup>[49]</sup> However, presence of the dimple sign does not always assure the lesion is dermatofibroma, <sup>[50]</sup> and dermatoscopy may be useful in supporting the clinical impression. <sup>[51]</sup>  The extremities are the most common sites of involvement, particularly the legs.<sup>[19, 20]</sup> Although any cutaneous site can be seen, palm, sole, digital, oral, and genital involvement is relatively rare. Giant (>5 cm in diameter), <sup>[52]</sup> atrophic, <sup>[53]</sup>polypoid, <sup>[54]</sup> and dermatofibroma with spreading satellitosis <sup>[55]</sup> variants have been reported. The largest reported tumor was 17 x 9 x 4 cm. <sup>[56]</sup>  Multiple clustered dermatofibromas <sup>[48]</sup> are rare and can mimic dermatofibrosarcoma protuberans. This phenomenon has been reported in a segmental distribution. <sup>[57]</sup>  A halo of dermatitis (Meyerson phenomenon) surrounding a dermatofibroma occurred in one patient.
Dermatofibromas typically present as firm, often hyperpigmented, nodules 0.3 to 1 cm in diameter (picture 4A-B), but giant lesions larger than 3 cm in diameter have been described [11,12]. They occur most often in adults and are most commonly located on the lower extremities. Lesions are usually asymptomatic, but may be pruritic. On palpations, dermatofibromas are fixed to the subcutaneous tissues and characteristically dimple when pinched


===Extremities===
===Extremities===

Revision as of 15:12, 31 July 2019


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Homa Najafi, M.D.[2] Kiran Singh, M.D. [3]

Overview

Dermatofibromas can be found anywhere on the body, but most often they are found on the legs and arms.

Physical Examination

Dermatofibromas can be found anywhere on the body, but most often they are found on the legs and arms. A dermatofibroma is associated with the dimple sign; by applying lateral pressure, there is a central depression of the dermatofibroma.

Skin

Extremities

  • Hard papules (rounded bumps) that may appear in a variety of colors, usually brownish to tan.
    • Especially found on the legs.

Overview

Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


Physical Examination

Physical examination of patients with [disease name] is usually normal.

OR

Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Skin

  • Skin examination of patients with dermatofibroma may show:[1][2][3][4][5]
    • Nodule with 0.3 to 1 cm in diameter
      • Note : Gient (> 5 cm) are also reported.
    • non-tender nodule
      • Note: Manipulation can cause tenderness
    • Hyperpigmentation
    • Dimple sign ( lateral compression on the skin makes a depression)
      • Note: Dimple sign can also seen in other skin diseases.
    • Puritic nodule ( may happen by superinfection)


Extremities

  • Extremities examination of patients with [disease name] is usually normal.

OR

  • Clubbing
  • Cyanosis
  • Pitting/non-pitting edema of the upper/lower extremities
  • Muscle atrophy
  • Fasciculations in the upper/lower extremity


References

  1. ↑ Lee, MiWoo; Lee, WooJin; Jung, JoonMin; Won, ChongHyun; Chang, SungEun; Choi, JeeHo; Moon, KeeChan (2015). "Clinical and histological patterns of dermatofibroma without gross skin surface change: A comparative study with conventional dermatofibroma". Indian Journal of Dermatology, Venereology, and Leprology. 81 (3): 263. doi:10.4103/0378-6323.154795. ISSN 0378-6323.
  2. ↑ Mentzel, Thomas; Wiesner, Thomas; Cerroni, Lorenzo; Hantschke, Markus; Kutzner, Heinz; Rütten, Arno; Häberle, Michael; Bisceglia, Michele; Chibon, Frederic; Coindre, Jean-Michel (2012). "Malignant dermatofibroma: clinicopathological, immunohistochemical, and molecular analysis of seven cases". Modern Pathology. 26 (2): 256–267. doi:10.1038/modpathol.2012.157. ISSN 0893-3952.
  3. ↑ Fitzpatrick, Thomas B.; Gilchrest, Barbara A. (1977). "Dimple Sign to Differentiate Benign from Malignant Pigmented Cutaneous Lesions". New England Journal of Medicine. 296 (26): 1518–1518. doi:10.1056/NEJM197706302962610. ISSN 0028-4793.
  4. ↑ Marc Pusztaszeri, Pierre-Yves Jaquet & Carole Williamson (2011). "Giant hemosiderotic dermatofibroma: a case report and review of the literature". Case reports in dermatology. 3 (1): 32–36. doi:10.1159/000324721. PMID 21487458. Unknown parameter |month= ignored (help)
  5. ↑ L. Requena, M. C. Farina, C. Fuente, E. Pique, M. Olivares, L. Martin & E. Sanchez Yus (1994). "Giant dermatofibroma. A little-known clinical variant of dermatofibroma". Journal of the American Academy of Dermatology. 30 (5 Pt 1): 714–718. PMID 8176009. Unknown parameter |month= ignored (help)
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