Dermatofibroma with seborrheic keratosis-like changes: a dermoscopic challenge. Diagnosis: Dermatofibroma with seborrheic keratosis-like changes

Features of dermatofibroma in reflectance confocal microscopy

BACKGROUND

Dermatofibroma (DF) is a common benign skin lesion in a majority of cases located on the legs or upper limbs. The etiology of DF is still unclear.

OBJECTIVES

Reflectance confocal microscopy features of DF were described.

METHODS

Forty patients with DF diagnosis confirmed by dermoscopy were examined using reflectance confocal microscopy VivaScope 1500 from March 2018 to April 2019.

RESULTS

DF was more common in females (80%) than males (20%). Thirty-six lesions (90%) were located on the limbs while four (10%) were on the trunk. Dermoscopically, 18 lesions (45%) revealed typical features: central white area with a brown network in the periphery. Twenty-two DFs (55%) were found with a central white patch and globular-like structures, surrounded by a thin brown network. In reflectance confocal microscopy, all revealed a typical honeycombed pattern, although in some cases (30%), streaming was observed. In two lesions (5%) in epidermis, few dendritic cells were observed, and one DF revealed roundish pagetoid cells (2.5%). The dermoepidermal junction (DEJ) in all lesions was abounded in dilated vessels. The most common observable feature of DF was bright "rings" composed of monomorphic, regular cells surrounding dark dermal papillae. In five lesions (12.5%), rings were "double" because of exceptionally pigmented DF.

CONCLUSION

Reflectance confocal microscopy enables us to describe microscopic features of DF. There are four confocal microscopic features observable in each DF: in the epidermis, normal honeycombed pattern, sometimes with local streaming, in DEJ, edged papillae, bright rings, and dilated vessels.

Beyond classic dermoscopic patterns of dermatofibromas: a prospective research study

BACKGROUND

The usual stereotypical dermoscopic pattern associated with dermatofibromas is a pigment network and central white patch. However, this pattern may be difficult to diagnose in some variant cases. We aimed to describe dermoscopic patterns of dermatofibroma according to its histopathological subtypes, with special emphasis on new and rare dermoscopic features.

METHODS

This prospective study, which was conducted between September 2015 and May 2016 in the Department of Dermatology, University Hospital Hassan II, Fez, Morocco, included 100 cases of dermatofibroma confirmed on clinical and histological grounds. Each lesion was scored for classic, previously reported, or new dermoscopic features.

RESULTS

All our Moroccan patients had a dark skin phototype (Fitzpatrick scale types IV and V). A total of 14 morphological dermoscopic structures were distinguished, and 17 dermoscopic patterns were observed, with the most common pattern being the central white patch and peripheral pigment network (21%). New patterns observed in our study were a white ring around an ulceration (6%), a pigment network with a pigmented ring around follicular openings (2%), and a discreet peripheral network and starlike white patch (3%). A patchy network with white patches was significantly noted in atrophic dermatofibroma (p = 0.01); vascularization was described in both aneurysmal and hemosiderotic dermatofibromas (p = 0.002); and a white ring around an ulceration was noted in aneurysmal dermatofibroma (p < 0.001).

CONCLUSIONS

We provide a description of dermoscopic patterns of dermatofibroma according to its histological subtypes in a dark skin phototype, along with a new report of a white ring around an ulceration as a significant pattern in aneurysmal dermatofibroma.