Dermatofibroma, histiocytoma, DF

Last Updated: 2023-07-07

Author(s): Anzengruber F., Navarini A.

ICD11: 2F23.0

  • Histiocytoma, dermatofibroma lenticulare, fibrome en pastille, hard fibroma.

Mostly women in young adulthood, but also older people. The prevalence is around 50%. Histiocytomas are often not immediately presented to dermatologists

In addition to dermatofibroma vulgaris, there are several subtypes that can be primarily differentiated dermatopathologically:

Histological structure:

Ossifying, sclerosing, desmoplastic, myxoid, xanthomatous, haemosiderotic


Deep infiltrating, facial area

Cellular architecture / typology:

Cell-rich (high recurrence rate, in males on legs), granular cell-containing, neurothekeoma, DF with monster cells, epithelioid cellular, pseudosarcomatous, metastatic,

  • It is unclear whether this is a neoplasm or a skin reaction pattern. However, dendritic cell markers are indeed found, suggesting a relationship with the non-Langerhans cell histiocytoses. Since certain histiocytoma types tend to recur, this may also postulate the neoplasia.
  • Trigger
    • Ictus reaction
    • Folliculitis
    • Ruptured cyst
    • Microtrauma
  • There is a subsequent inflammatory connective tissue reaction

  • Mostly on the lower extremity, a red/brown, sharply demarcated, lenticular nodule is seen
  • If the skin lesion is fixed between the thumb and index finger, the nodule sinks (Fitzpatrick's sign)
  • Unusually large dermatofibromas are called giant dermatofibromas

  • Clinic
  • Dermatoscopic pattern:
  • Brown, rather light pigment network in the periphery of the lesion. No sharp demarcation against the surrounding skin. A scar is found in the centre of the lesion, which may be bizarre and irregularly configured. With polarisation, "shiny white lines" are found.
  • Papular changes with pigment network should be excised if uncertain, no prolonged observation period recommended. Unfortunately, dermatofibromas have already turned out to be melanomas several times - deep-threshold excisions are useful and should also always be covered by the insurance company.

Extremities, especially legs, are the most frequent localisation. Dermatofibromas are rare on the face (separate subtype).

  • Thickened (acanthotic) epidermis
  • No sharp border to side and base
  • No capsule
  • Diffuse collections of spindle cells, some containing lipid or haemosiderin
  • Subtypes: Cellular, Aneurismal, Epithelioid, Atypical, Lipid-containing, Cholesterol-containing, Palisade DF (see also at Classification).

  • May bleed in trauma
  • Differential diagnosis of amelanotic melanoma may be missed for a long time, there are known legal cases on this

Does not start, but persists for a long time.

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  3. Kamino H, Jacobson M. Dermatofibroma Extending into the Subcutaneous Fat. The American Journal of Dermatopathology 1990;12:315.
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  9. Kim HJ, Lee JY, Kim SH, et al. Stromelysin-3 expression in the differential diagnosis of dermatofibroma and dermatofibrosarcoma protuberans: comparison with factor XIIIa and CD34. Br J Dermatol 2007;157:319-24.