Treating A Pigmented, Slightly Pruritic Nodule

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Author(s): 
By G. “Dock” Dockery, DPM, FACFAS

Injections with intralesional corticosteroids may decrease the size and color of lesions. In many cases, the steroid will make them softer. Steroid injections are not considered to be highly successful and have some potential complications of atrophy, discoloration and/or telangiectasia. Some physicians have stopped recommending this approach. Cryosurgery is also useful in flattening and decreasing the color of lesions. This approach does not have the potential side effects of steroid injections.

Since dermatofibromas are deep lesions with widened bases, simple excision of the lesion may result in unsightly, thick and dark scars. Recurrences are common. Wide excision of the lesion and complete removal of the deep portions of the mass are necessary to prevent return of the lesion. One may subsequently close the resultant defect with a variety of reciprocal flaps used for closing circular defects or with a single-lobed flap. One should submit all removed specimens for dermatopathology confirmation of the diagnosis of dermatofibroma.




References:

Suggested Reading
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2. Dockery GL. Benign tumors, cysts, and lesions, ch. 13, in: Cutaneous Disorders of the Lower Extremity. W.B. Saunders Co., Philadelphia, pp. 204-205, 1997.
3. Dockery GL. Advancement and rotational flaps. Ch 15, pp 129-146, In: Dockery GL, Crawford ME (eds): Lower Extremity Soft Tissue & Cutaneous Plastic Surgery, Elsevier Science Limited (Saunders), Oxford-Philadelphia, 2006.
4. Dockery GL, Schroeder S. How to diagnose and treat insect bites and stings, Podiatry Today. 19(6):90-98, 2006.
5. Fitzpatrick TB, Gilchrest BD. Dimple sign to differentiate benign from malignant pigmented cutaneous lesions. N Engl J Med, 296:1518, 1977.
6. Hendi A, Jukie DM, Kress DW, Brodland DG. Atrophic dermatofibroma: a case report and review of the literature. Dermatol Surg. 28(11):1085-1087, 2002.
7. Kovach BT, Boyd AS. Melanoma associated with a dermatofibroma. J Cutan Pathol. 34(5):420-422, 2007.
8. Lanigan SW, Robinson TW. Cryotherapy for dermatofibromas. Clisn Exp Dermatol, 12:121-123, 1987.
9. Laughlin CL, Carrington PR. Deep penetrating dermatofibroma. Dermatol Surg. 24(5):592-594, 1998.
10. Naversen DN, Trask DM, Watson FH, Burket JM. Painful tumors of the skin: “LEND AN EGG.” J Am Acad Dermatol. 28:298-300, 1993.
11. Pierson JC, Pierson DM. Dermatofibroma. eMedicine, July 2007. Available at: http://www.emedicine.com/DERM/topic96.htm
12. Requena L, Farina MC, Fuente C, Pique E, et. al. Giant dermatofibroma. A little-known clinical variant of dermatofibroma. J Am Acad Dermatol. 305:714-718, 1994.
13. Zelger B, Zelger BG, Burgdorf WH. Dermatofibroma- a critical evaluation. Int J Surg Pathol. 12(4):333-334, 2004.

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