Journal of Cutaneous and Aesthetic Surgery
Print this page
Email this page
Small font size
Default font size
Increase font size
Home About us Current issue Archives Instructions Submission Subscribe Editorial Board Partners Contact e-Alerts Login 


 
   Table of Contents     
QUIZ  
Year : 2016  |  Volume : 9  |  Issue : 2  |  Page : 129-131
A solitary firm nodule on the palm


Department of Dermatology, Venereology and Leprosy, SBMP Medical College, Hospital and Research Center, BLDE University, Vijayapur, Karnataka, India

Click here for correspondence address and email

Date of Web Publication15-Jun-2016
 

How to cite this article:
Adya KA, Inamadar AC, Palit A. A solitary firm nodule on the palm. J Cutan Aesthet Surg 2016;9:129-31

How to cite this URL:
Adya KA, Inamadar AC, Palit A. A solitary firm nodule on the palm. J Cutan Aesthet Surg [serial online] 2016 [cited 2019 Oct 19];9:129-31. Available from: http://www.jcasonline.com/text.asp?2016/9/2/129/184045


A 60-year-old female presented with a gradually enlarging asymptomatic lesion on the right palm from the past 8 months [Figure 1]. The general health of the patient was otherwise unremarkable and she denied any history of preceding trauma. Clinical examination revealed a 1 cm × 1 cm firm, non-tender dome-shaped nodule on the right palm near the base of index finger surrounded by a rim of thick raised skin [Figure 2]. The entire lesion was excised under local anesthesia and hematoxylin and eosin examination revealed a hyperkeratotic epidermis with subjacent dense fibrocollagenous mass with numerous interspersed blood vessels [Figure 3].
Figure 1: A 1 cm × 1 cm, dome shaped nodule near the base of index finger on right palm

Click here to view
Figure 2: Close-up view of the lesion showing a nodule with a peripheral collarette of raised skin

Click here to view
Figure 3: Acanthotic epidermis overlying dense fibrocollagenous mass in the reticular dermis with numerous interspersed blood vessels (H and E, ×100)

Click here to view


What is your diagnosis?


   Answer Top


Quiz - Answer: Acral fibrokeratoma.

Acral fibrokeratoma is an acquired benign tumor often seen in adults. The tumor is often solitary and frequently occurs on the digits and hence usually referred to as acquired digital fibrokeratoma. The characteristic feature of the tumor is the moat-like collarette of hyperkeratotic skin that surrounds a central firm papule or nodule that may have a warty surface. Histologically, increased vertically oriented collagen fibers together with increased blood vessels in the dermis are noted underlying a hyperkeratotic and acanthotic epidermis.[1] Dermoscopy usually shows a central homogenous pale yellowish area reflecting the central increased dermal collagen with peripheral white scaly collarette [Figure 4].[2] Differential diagnoses include eccrine poroma, pyogenic granuloma, a rudimentary supernumerary digit, viral wart, dermatofibroma, and a cutaneous horn.[3],[4] The first three may also have a collarette of skin surrounding the central lesion but can be differentiated histopathologically from fibrokeratoma. Acral fibrokeratoma may be almost indistinguishable clinically from a rudimentary supernumerary digit when located at the base of little finger. However, the supernumerary digit is congenital and although histologically quite similar to fibrokeratoma, presence of increased nerve bundles at the center of the lesion helps in differentiating it from fibrokeratoma. The periungal fibromas of tuberous sclerosis (Koenen tumor) should also be considered which also show the clinical and histological resemblance.[5] Simple excision is curative.[3]
Figure 4: Dermoscopy under polarized light showing central pale area indicative of increased fibrocollagenous tissue with peripheral scaling

Click here to view


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Adya KA, Palit A, Inamadar AC. Keratotic papule with a collarette of skin. Indian J Dermatol 2012;57:164-5.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Rubegni P, Poggiali S, Lamberti A, Chiantini A, De Paola M, Peccianti C, et al. Dermoscopy of acquired digital fibrokeratoma. Australas J Dermatol 2012;53:47-8.  Back to cited text no. 2
    
3.
Calonje E. Soft-tissue tumours and tumour-like conditions. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook's Textbook of Dermatology, 8th ed. Oxford: Wiley-Blackwell; 2010. p. 56.1-65.62.  Back to cited text no. 3
    
4.
Kamino H, Meehan SA, Pui J. Fibrous and fibrohistiocytic proliferations of the skin and tendons. In: Bolognia JL, Jorizzo JL, Rapini RP. editors. Dermatology. 2nd ed. London: Elsevier; 2008. p. 1813-29.  Back to cited text no. 4
    
5.
Kint A, Baran R. Histopathologic study of Koenen tumors. Are they different from acquired digital fibrokeratoma? J Am Acad Dermatol 1988;18(2 Pt 1):369-72.  Back to cited text no. 5
    

Top
Correspondence Address:
Arun C Inamadar
Department of Dermatology, Venereology and Leprosy, SBMP Medical College, Hospital and Research Center, BLDE University, Vijayapur - 586 103, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2077.184045

Rights and Permissions


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

Top
  
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


   Answer
    References
    Article Figures

 Article Access Statistics
    Viewed1890    
    Printed12    
    Emailed0    
    PDF Downloaded115    
    Comments [Add]    

Recommend this journal