DERMOSCOPY
CASES OF THE MONTH
Dermoscopy of acral fibromyxoma Marta Aguado, MD,a Carmen Meseguer, MD,b Juan C. Tardıo, MD, PhD,c and Jes us Borbujo, MD, PhDa Madrid and Zamora, Spain
CLINICAL PRESENTATION A 68-year-old woman presented with a 5-year history of a painful nodule in her right palm. The physical examination revealed an 8-mm erythematous to whitish firm round nodule (Fig 1).
Fig 1. Erythematous to whitish firm round nodule on the right palm.
DERMOSCOPIC APPEARANCE Dermoscopy revealed a total white, scar-like patch with shiny white streaks and small arborizing vessels with an in-focus central telangiectasia (Fig 2).
Fig 2. Dermoscopy reveals a total white, scar-like patch, shiny white streaks, and small arborizing vessels with an in-focus central telangiectasia.
From the Departments of Dermatologya and Pathology,c Hospital Universitario de Fuenlabrada, Madrid, and the Department of Dermatology, Complejo Asistencial de Zamorab,b Zamora. Funding sources: None. Conflicts of interest: None declared. Reprint requests: Marta Aguado, MD, Servicio de Dermatologıa, Hospital Universitario de Fuenlabrada, Camino del Molino 2,
28942 Fuenlabrada, Madrid, Spain. E-mail: martaaguadolobo@ yahoo.es. J Am Acad Dermatol 2014;70:e5-6. 0190-9622/$36.00 ª 2013 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2013.09.001
e5
e6 Aguado et al
J AM ACAD DERMATOL
JANUARY 2014
HISTOLOGIC DIAGNOSIS The histologic diagnosis was acral fibromyxoma (AF), which revealed a highly vascularized collagenous-type stroma with sclerotic areas (Fig 3).
Fig 3. Bland fibroblastic cells arranged in a random pattern within a dense collagenous stroma. (Hematoxylineeosin stain.)
KEY MESSAGE AF is an uncommon benign tumor of the superficial soft tissues of the acral extremities with typical clinical, histopathologic, and immunohistochemical features.1 Histopathologically, it consists of CD34-reactive spindle- and stellate-shaped cells arranged in a random, loose storiform and/or fascicular growth pattern, and embedded in a myxoid, myxocollagenous, or fibrous stroma with prominent vasculature.1 In the current case, the dermoscopic examination revealed arborizing vessels, which may also be detected in basal cell carcinoma (BCC) and adnexal tumors.2 It might represent the prominent vasculature typical of AF. In addition, the total white, scar-like patch could be caused by sclerotic areas, and it is also observed in dermatofibroma, but this tumor does not have arborizing central telangiectasia.3 Shiny white streaks are frequently seen in skin lesions with increased amounts of dermal collagen, including dermatofibromas, melanoma, BCC, and Spitz nevi.3 To our knowledge, this is the first report that discusses a dermoscopic image of an AF. Although it would be necessary to conduct more studies, dermoscopy could be a helpful adjuvant diagnostic tool for AF.
REFERENCES 1. Hollmann TJ, Bovee JV, Fletcher CD. Digital fibromyxoma (superficial acral fibromyxoma): a detailed characterization of 124 cases. Am J Surg Pathol 2012;36:789-98. 2. Zalaudek I, Kreusch J, Giacomel J, Ferrara G, Catricala C, Argenziano G. How to diagnose nonpigmented skin tumors: a review of vascular structures seen with dermoscopy. Part II. Nonmelanocytic skin tumors. J Am Acad Dermatol 2010;63:377-86. 3. Martın JM, Bella-Navarro R, Jorda E. Vascularizaci on en dermatoscopia. Actas Dermosifiliogr 2012;103:357-75.
CASES OF THE MONTH
Dermoscopy of acral fibromyxoma Marta Aguado, MD,a Carmen Meseguer, MD,b Juan C. Tardıo, MD, PhD,c and Jes us Borbujo, MD, PhDa Madrid and Zamora, Spain
CLINICAL PRESENTATION A 68-year-old woman presented with a 5-year history of a painful nodule in her right palm. The physical examination revealed an 8-mm erythematous to whitish firm round nodule (Fig 1).
Fig 1. Erythematous to whitish firm round nodule on the right palm.
DERMOSCOPIC APPEARANCE Dermoscopy revealed a total white, scar-like patch with shiny white streaks and small arborizing vessels with an in-focus central telangiectasia (Fig 2).
Fig 2. Dermoscopy reveals a total white, scar-like patch, shiny white streaks, and small arborizing vessels with an in-focus central telangiectasia.
From the Departments of Dermatologya and Pathology,c Hospital Universitario de Fuenlabrada, Madrid, and the Department of Dermatology, Complejo Asistencial de Zamorab,b Zamora. Funding sources: None. Conflicts of interest: None declared. Reprint requests: Marta Aguado, MD, Servicio de Dermatologıa, Hospital Universitario de Fuenlabrada, Camino del Molino 2,
28942 Fuenlabrada, Madrid, Spain. E-mail: martaaguadolobo@ yahoo.es. J Am Acad Dermatol 2014;70:e5-6. 0190-9622/$36.00 ª 2013 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2013.09.001
e5
e6 Aguado et al
J AM ACAD DERMATOL
JANUARY 2014
HISTOLOGIC DIAGNOSIS The histologic diagnosis was acral fibromyxoma (AF), which revealed a highly vascularized collagenous-type stroma with sclerotic areas (Fig 3).
Fig 3. Bland fibroblastic cells arranged in a random pattern within a dense collagenous stroma. (Hematoxylineeosin stain.)
KEY MESSAGE AF is an uncommon benign tumor of the superficial soft tissues of the acral extremities with typical clinical, histopathologic, and immunohistochemical features.1 Histopathologically, it consists of CD34-reactive spindle- and stellate-shaped cells arranged in a random, loose storiform and/or fascicular growth pattern, and embedded in a myxoid, myxocollagenous, or fibrous stroma with prominent vasculature.1 In the current case, the dermoscopic examination revealed arborizing vessels, which may also be detected in basal cell carcinoma (BCC) and adnexal tumors.2 It might represent the prominent vasculature typical of AF. In addition, the total white, scar-like patch could be caused by sclerotic areas, and it is also observed in dermatofibroma, but this tumor does not have arborizing central telangiectasia.3 Shiny white streaks are frequently seen in skin lesions with increased amounts of dermal collagen, including dermatofibromas, melanoma, BCC, and Spitz nevi.3 To our knowledge, this is the first report that discusses a dermoscopic image of an AF. Although it would be necessary to conduct more studies, dermoscopy could be a helpful adjuvant diagnostic tool for AF.
REFERENCES 1. Hollmann TJ, Bovee JV, Fletcher CD. Digital fibromyxoma (superficial acral fibromyxoma): a detailed characterization of 124 cases. Am J Surg Pathol 2012;36:789-98. 2. Zalaudek I, Kreusch J, Giacomel J, Ferrara G, Catricala C, Argenziano G. How to diagnose nonpigmented skin tumors: a review of vascular structures seen with dermoscopy. Part II. Nonmelanocytic skin tumors. J Am Acad Dermatol 2010;63:377-86. 3. Martın JM, Bella-Navarro R, Jorda E. Vascularizaci on en dermatoscopia. Actas Dermosifiliogr 2012;103:357-75.
