Tuesday, March 14, 2006

Digital Tumor

This 61 yo man presented with a 30 year history of an annoying tumor of his right index finger. It interferes with his writing in that it abuts on the area in contact with a pen or pencil. He has pared it down on numerous occasions and it has been unsuccessfully treated with cryotherapy in the past. The clinical picture is that of an acquired digital fifrokeratoma (see reference below). An excisional biopsy is scheduled.

Dupre A, Christol B, Bories M.
[Acquired fibro-keratoma. Report of 8 cases]
Ann Dermatol Venereol. 1977 Oct;104(10):611-5. [Article in French]

The acquired fibro-keratoma is a benign fibro-epithelial tumor of acquired
nature. I was set apart as a distinct entity in 1968 by Bart et al. who named it
"acquired digital fibro-keratoma". It is predominantly, although not
exclusively, located on the fingers and toes, near the phalangeal joints. The
authors report 8 personal cases and make a short general review of the disease.
The lesion is slightly prominent, well defined and surrounded by a
hyperkeratotic collar. It protrudes on the surface of the skin much like a
hernia. Histologically, it is a dermo-epidermal tumor. There is a proliferation
of connective tissue under the papillomatous, hyperacanthotic and orthokeratotic
epidermis. The mature collagen bundles, voluminous fibroblasts and numerous
enlarged capillaries are parallel to the vertical axis of the tumor. The
acquired fibrokeratoma must be differentiated from other cutaneous tumors,
particularly fibromas and Koenen's tumors. The etiology is unknown. However, it
was found in some cases that a trauma had contributed to the development of the
tumor. The only possible treatment is surgical excision.

1 comment:

  1. Only an histological study will confirm the dianosis. Let us not be surprised if there is vascular proliferation with an epidermal collarette as in granuloma pyogenicum!!


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