Dermatofibromas are common, benign skin growths. While typically harmless, many individuals consider their removal. This article explores their characteristics and various treatment options.
What Are Dermatofibromas?
Dermatofibromas are firm, non-cancerous skin lesions, which typically measure less than 1.5 centimeters in diameter. They often present as reddish-brown to purple nodules, though their color can vary, sometimes appearing pink, gray, or even black. These growths commonly develop on the extremities, particularly the lower legs and arms, but can appear anywhere on the body. A distinguishing characteristic is the “dimple sign” or “pinch test,” where the lesion dimples inward when the surrounding skin is gently squeezed. This occurs because the growth is tethered to the underlying subcutaneous tissue. While usually asymptomatic, some dermatofibromas can be itchy, tender, or occasionally painful.
When Is Removal Recommended?
While dermatofibromas are benign and generally do not require removal for medical reasons, individuals consider treatment for various reasons. Cosmetic concerns are a common reason, especially if the lesion is prominent or located in a visible area like the face, neck, or arms. Its appearance can impact self-confidence. Discomfort is another common motivation for removal; dermatofibromas can become irritated, painful, or itchy, particularly if they are in an area subject to friction from clothing or shaving. If a lesion consistently causes physical symptoms, removal can provide relief. Removal is also recommended due to diagnostic uncertainty, allowing for a pathological examination to confirm the benign nature of the growth and rule out other conditions.
Non-Surgical Approaches
Non-surgical methods aim to reduce the size or appearance of dermatofibromas without cutting. Cryotherapy, which involves freezing the lesion with liquid nitrogen, can flatten the dermatofibroma. Multiple sessions may be required to achieve desired outcomes, and temporary side effects like redness, swelling, or blistering can occur. Laser therapy can also be used to target and break down the fibrous tissue within the lesion. Pulsed dye lasers may address redness, while fractional lasers can improve texture. This method offers precision and can reduce bleeding during the procedure, though complete disappearance is less common, and several sessions are often necessary for optimal flattening. Intralesional corticosteroid injections involve injecting steroids directly into the dermatofibroma to reduce its size and inflammation. These non-surgical treatments generally flatten the lesion rather than completely removing it, and the deeper parts of the growth may remain.
Surgical Removal Methods
For complete removal of dermatofibromas, surgical methods are generally most effective. One common technique is excisional biopsy, which involves surgically removing the entire lesion along with a small margin of surrounding tissue. This procedure is typically performed under local anesthesia, meaning the patient is awake but the area is numbed. The incision is then closed with sutures. Excisional biopsy is highly effective for complete removal and allows for a definitive pathological examination of the tissue, crucial for confirming diagnosis and ruling out other conditions. Another surgical option is shave excision, where the lesion is shaved off with a scalpel, leaving a flatter surface. While less invasive, shave excision carries a higher chance of recurrence because deeper portions of the dermatofibroma may not be entirely removed. Both procedures are usually outpatient, allowing patients to return home the same day.
Recovery and Potential Recurrence
Following dermatofibroma removal, recovery time varies by method. For surgical excisions, initial healing typically takes 7-14 days, with complete skin remodeling occurring over several months. Wound care instructions are provided to support proper healing. Some redness or tenderness at the site is common during the initial recovery period. Scarring is an expected outcome with surgical removal. While surgeons aim to minimize scarring, its appearance can vary, but it often fades over time with proper care, including sun protection. Despite removal, dermatofibromas can sometimes recur, particularly with shave excision, which has a higher chance of leaving behind residual cells. Even after a complete excisional biopsy, a new lesion can occasionally form in the same or a nearby area.