Dermoscopic Patterns of Dermatofibroma in 72 Chinese Patients
Dermatofibroma, a common benign tumor of the skin, is composed of fibrohistiocytic cells and can occur anywhere on the body, with a predilection for the extremities in adult patients. Clinically, dermatofibromas present as firm, single or multiple hard papules, plaques, or nodules with a smooth surface. The color of these lesions typically ranges from light brown to dark brown, purple-red, or yellow. A characteristic feature of dermatofibroma is the dimple sign, where lateral compression of the tumor produces a dimple-like depression in the overlying skin. Dermoscopy, a non-invasive diagnostic tool, is widely used in the evaluation and management of pigmented skin tumors.
This study aimed to evaluate the dermoscopic patterns of dermatofibromas in 72 Chinese patients who visited the Outpatient Department of Dermatology at Jiangsu Province Hospital between January 2018 and April 2019. The study was approved by the Ethics Committee of Jiangsu Province Hospital, and informed consent was obtained from all participants. Clinical data, including patient age, gender, lesion location, and characteristics, were collected. All dermatofibromas were examined using a DermLite® DL1 dermoscope (3 Gen Inc., San Juan Capistrano, CA, USA) in contact mode with polarized light. Each lesion was subsequently excised, and the diagnosis of dermatofibroma was confirmed histopathologically. The lesions were scored for global and local dermoscopic patterns based on previously established criteria. Statistical analysis was performed using the Chi-square test, with P values <0.05 considered statistically significant. Data were analyzed using SPSS software (version 20.0; SPSS Inc, Chicago, IL, USA).
The study included 82 dermatofibromas from 46 women (63.9%) and 26 men (36.1%), with a female-to-male ratio of 1.8:1. The age of the patients ranged from 18 to 71 years, with a median age of 40 years. Women had more dermatofibromas on the limbs (n=42, 51.2%) and trunk (n=10, 12.2%) compared to men (n=19, 23.2% on the limbs and n=11, 13.4% on the trunk). Overall, dermatofibromas were more frequently located on the limbs (n=61, 74.4%) than on the trunk (n=21, 25.6%). The most common clinical presentation was papules (n=42, 51.2%).
The dermoscopic patterns observed in this study were consistent with those identified by Zaballos et al. The most prevalent pattern was the peripheral delicate pigment network and central white network (n=17, 20.7%, Figure 1C). This was followed by the multiple white scar-like patches pattern (n=11, 13.4%, Figure 1H), total delicate pigment network pattern (n=11, 13.4%, Figure 1A), total homogeneous area pattern (n=9, 11.0%, Figure 1F), peripheral delicate pigment network and central white scar-like patch pattern (n=7, 8.5%, Figure 1B), peripheral homogeneous area and central white scar-like patch pattern (n=7, 8.5%, Figure 1I), peripheral delicate pigment network and central homogeneous area pattern (n=6, 7.3%, Figure 1D), total white network pattern (n=6, 7.3%, Figure 1E), atypical pattern (n=4, 4.9%, Figure 1K), total white scar-like patch pattern (n=2, 2.4%, Figure 1G), and peripheral homogeneous area and central white network pattern (n=2, 2.4%, Figure 1J).
No significant associations were found between dermoscopic patterns and patient age, lesion location, or gender (P>0.05). The peripheral delicate pigment network and central white network pattern was most frequently observed on the limbs (n=15, 18.3%), while the peripheral delicate pigment network and central homogeneous area pattern was more common on the trunk (n=5, 6.1%). The peripheral delicate pigment network and central white network pattern was the predominant pattern across all age groups: ≤40 years (8.5%), 41-60 years (8.5%), and >60 years (3.7%). This pattern was also the most common in both men (9.8%) and women (10.9%).
The findings of this study highlight the variability in dermoscopic patterns of dermatofibromas among Chinese patients. The most prevalent pattern, the peripheral delicate pigment network and central white network, accounted for 20.7% of the lesions. This distribution may be influenced by the Fitzpatrick skin phototype, particularly phototype III, which is common in Chinese populations. Previous studies, such as those by Kelati et al., have described additional dermoscopic patterns in dermatofibromas, including pigmented rings around follicular openings in dark-skinned patients. These patterns differ from the small ring-like structures or globules with a darker peripheral rim reported in other studies.
The study also underscores the importance of dermoscopy in the diagnostic evaluation of dermatofibromas. By providing detailed visualization of the lesion’s structural and pigmentary features, dermoscopy aids in distinguishing dermatofibromas from other pigmented skin tumors. The absence of significant associations between dermoscopic patterns and demographic factors suggests that these patterns are primarily influenced by the intrinsic characteristics of the lesion rather than external variables.
In conclusion, this study provides a comprehensive analysis of the dermoscopic patterns of dermatofibromas in Chinese patients. The findings contribute to the growing body of knowledge on the dermoscopic features of dermatofibromas and highlight the role of dermoscopy in enhancing diagnostic accuracy. Further research is warranted to explore the dermoscopic characteristics of dermatofibromas in diverse populations and to identify potential correlations with histopathological features.
doi.org/10.1097/CM9.0000000000000406
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