Dermatofibroma 101 (Benign Fibrous Histiocytoma)...Explained by a Dermatopathologist

A complete organized library of all my videos, digital slides, pics, & sample pathology reports is available here: kikoxp.com/posts/5084 (dermpath) & kikoxp.com/posts/5083 (bone/soft tissue sarcoma pathology).
Dermatofibroma (aka benign fibrous histiocytoma) is one of the most common spindle cell lesions in the skin, but they can sometimes be tricky to recognize because there are so many different histologic variations. This video explains the "classic" findings and clues that help one recognize dermatofibroma microscopically. From here, the more unusual and esoteric "flavors" of dermatofibroma can then be learned.
Recommended videos re: dermatofibroma and entities in the differential diagnosis:
- Dermatofibroma 101: kikoxp.com/posts/3895
- Aneurysmal dermatofibroma: kikoxp.com/posts/4449
- Angiomatoid fibrous histiocytoma (NOT related to aneurysmal DF!): kikoxp.com/posts/4272
- Lipidized (ankle type) dermatofibroma: kikoxp.com/posts/4450
- Cellular dermatofibroma (cellular fibrous histiocytoma): kikoxp.com/posts/4452
- DFSP (dermatofibrosarcoma protuberans): kikoxp.com/posts/4451
This video is geared towards medical students, pathology or dermatology residents, or practicing pathologists or dermatologists. Of course, this video is for educational purposes only and is not formal medical advice or consultation.
Presented by Jerad M. Gardner, MD. Please subscribe to my channel to be notified of new pathology teaching videos.
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[@JMGardnerMD]

A complete organized library of all my videos, digital slides, pics, & sample pathology reports is available here: kikoxp.com/posts/5084 (dermpath) & kikoxp.com/posts/5083 (bone/soft tissue sarcoma pathology). Recommended videos re: dermatofibroma and entities in the differential diagnosis: - Dermatofibroma 101: kikoxp.com/posts/3895 - Aneurysmal dermatofibroma: kikoxp.com/posts/4449 - Angiomatoid fibrous histiocytoma (NOT related to aneurysmal DF!): kikoxp.com/posts/4272 - Lipidized (ankle type) dermatofibroma: kikoxp.com/posts/4450 - Cellular dermatofibroma (cellular fibrous histiocytoma): kikoxp.com/posts/4452 - DFSP (dermatofibrosarcoma protuberans): kikoxp.com/posts/4451

[@dryusra1702]

Soo informative. Everytime i plan to study a topic. I decide to go through ur videos first and add the pearls in my book. Waiting for DFSP video. Thank youuu for ur time and effort.

[@janiranavarro]

Great video Dr Jerad!! Thank you for showing the many faces of dermatofibroma!!!

[@user-qq3ws2ex8p]

I always hated histopathology till I came across your account ,very simple and informative.

[@fahmidasiddika4013]

Thank you so much. Each and every video is so helpful. Thank you for all the efforts. We enjoy each and every video of yours

[@mhdqr897]

A most informative and practical video, much appreciated for your effort and time. I hope to see more of these mini series in the future, they are easy to digest, more focused and intensely useful.

[@JMGardnerMD]

Thanks very much for that feedback! I plan to do more like this.

[@ivobuters8775]

Very helpful Jerad ! from a skin cancer doctor in Western Australia

[@tracydahlke3002]

This was awesome! Thoroughly enjoyable.

[@JB-hf3ec]

I really love your lessons! I wish you could do more than DermatoPath. THANK YOU !!!

[@d-day3152]

Just had one of these removed from the back of my right hand recently & had 5 stitches that were taken out yesterday but the report i got from the doctor telling me what it was told me very little so i decided to research myself & found this informative interesting video, thanks.

[@JMGardnerMD]

Glad you enjoyed it! Yes dermatofibroma is pretty common. I have a tiny one on my own leg actually!

[@HRCPSCM]

hello dr .I am from Bangladesh ,,,,My sister develops pdfsp (bednar tumor),,,,on her upper wrist and by surgical removal it is ok,,,,,,,she is cured for 14 months more and mole stated 14 months ,total 28 months ,,,is there any possibilities to local recurrent or metastasize.Thanks in advance.

[@sarahloulou2613]

I have Seen a lot of your vidéos....they all are very instructive ans very useful in practice....thank you very much

[@adriennem3168]

I think I have this on the middle outside of my thigh. I wonder if my early severe sunburns as a child and a recent one later in life triggered it. Occasionally it is very itchy and annoying. I tried to scratch it off but what happens is the thin, smooth "dome" of surface skin scratches off, bleeds but eventually just heals around the bump.

[@zhannamussazhanova3267]

Awesome video!!Thank you !

[@malinigoswami8526]

Awesome video as always!!I think I am learning pathology all over again!! Any hints to rule out Benign fibrous histiocytoma ?

[@JMGardnerMD]

Thx! Dermatofibroma is the same thing as benign fibrous histiocytoma. They are just two different names for the same entity.

[@malinigoswami8526]

@@JMGardnerMD really!! didn't know that!thanx

[@JMGardnerMD]

Recommended videos re: dermatofibroma and entities in the differential diagnosis: - Dermatofibroma 101: kikoxp.com/posts/3895 - Aneurysmal dermatofibroma: kikoxp.com/posts/4449 - Angiomatoid fibrous histiocytoma (NOT related to aneurysmal DF!): kikoxp.com/posts/4272 - Lipidized (ankle type) dermatofibroma: kikoxp.com/posts/4450 - Cellular dermatofibroma (cellular fibrous histiocytoma): kikoxp.com/posts/4452 - DFSP (dermatofibrosarcoma protuberans): kikoxp.com/posts/4451

[@LOLsaudi]

Im curious to know if you have read the recent articles about using HMGA1 and 2 immunohistochemistry to diagnose difficult cases of dermatofibroma vs DFSP and what is your take on that immunostain

[@JMGardnerMD]

No I haven't read those articles yet. I find that H&E can distinguish DF vs DFSP in the vast majority of cases. CD34 helps when they are difficult. And when really difficult, I just do FISH for COL1A1-PDGFB (if negative I reflex to PDGFD). Hope to make a DFSP video eventually.

[@ellali1688]

Thank you so much!

[@ncorry8491]

Excellent thank you! Would some of the examples be considered as Cellular dermatofibromas?

[@JMGardnerMD]

Haven’t watched this whole video since I made it. But I don’t recall including any cellular DF. I was waiting to do a different video on that as it’s a bit more complicated.

[@kazumithumargondalia9171]

Superb..

[@oshisimo8503]

Thank u ,very helpful

[@thebasiclife4319]

It's really annoying if u don't know what it is, which gave a lot of stress that thought it was melanoma or Basal, I just went to my dermatologist this morning and has checked out , TOld that I don't have to worry about coz it's a benign tumor, and don't need treatment at all otherwise the scars would be worse.

[@alaynii]

I’m insecure about mine on my butt and I was thinking of just getting mine removed and if I get a weird scar do a cover up tattoo

[@JMGardnerMD]

Please see your dermatologist to discuss the pros and cons of having a biopsy or excision. Dermatofibroma is benign and doesn’t have to be removed (I have one on my leg). BUT...it can be difficult for a non-dermatologist to be sure that something is truly a Dermatofibroma just by looking at it. Other skin growths can mimic it and vice versa. Sometimes biopsy is needed to confirm the diagnosis. Your dermatologist can examine you and give you personalized advice. Best wishes for health and happiness.

[@ayronlp1534]

I think I have one of these on the back of my shoulder, the bump has been there a while, it’s gotten a little bigger over the years and the color is getting darker.. I want to get it removed

[@JMGardnerMD]

Many different skin diseases can closely resemble one another. If you have any concerning/changing/growing skin lesion, please see your dermatologist. They can help you decide if it should be biopsied or surgically removed so that a pathologist can examine it and diagnose it.

[@christopherma1718]

I have what appears dermatofibroma But have 8-10 mitosis / 10HPF What is your mitosis threshold from your experience

[@CeydaKl-gw6uv]

patoloji ile DF'yi belirlemek basit midir? genellikle ek işlem gerekir mi? Patoloji ilgimi çekiyor ☆

[@IsaHarrisonLennon]

They removed one from my back a year ago to analyze it and they said it was a dermatofibroma and now it has grown back, is it normal for it to grow back?

[@slawomirlech950]

They screwed up, didn't remove everything.

[@sandraruiz4456]

i cant believe that in 2020 still no solution for dermatofibroma i have that ugly thing on my brest and dermatolgist told me tha the scar would be worse, it really depressed me

[@JMGardnerMD]

They can be cured by surgical removal but yes it will leave a scar. If you would prefer having a scar instead of a dermatofibroma, I think that is your choice as a patient. Also, the only way to be 100% sure it is actually a dermatofibroma is to have it biopsied or surgically removed and then examined by a pathologist under the microscope. You might consider discussing it again with your dermatologist and explaining how much it bothers you, or you could seek a second opinion from a different dermatologist (Mohs surgeons are dermatologists who specialize in skin surgery) or a plastic surgeon. Best wishes for healing and good health.

[@Erikakovalsky]

@@JMGardnerMD I have one in my face 😭😭😭 I want to remove it

[@znrsmsaa3655]

Thanks alot

[@jannabeech7579]

Hi have you produced the video on DFSP yet? Thanks

[@JMGardnerMD]

No not yet. Hopefully soon!

[@ncorry8491]

@@JMGardnerMD Looking forward to a DFSP video

[@Jojobreez]

Why do you think my dermatologist treated this with steroids knowing results would be poor?

[@annie947]

Can this be treated with imiquimod cream? Can a biopsy be suggestive of dermatofibroma but in reality to be basal cell cancer? Can a biopsy miss skin cancer? I would be very happy if you can answer this questions! Thank you

[@JMGardnerMD]

I only diagnose skin disease, I don’t treat it. So I’m not an expert at treatment. But I’ve never heard of imiquimod being used to treat dermatofibroma. And logically to my mind it doesn’t seem like it would be likely to work. But you should ask your dermatologist about the best treatment options for you. Usually dermatologist can diagnose dermatofibroma by physical examination. Sometimes a biopsy is performed to determine if it is a dermatofibroma versus something else like BCC or other skin cancer. Once a diagnosis of Dermatofibroma is made, additional treatment is not usually required because they are benign (unless the Dermatofibroma is large or painful or otherwise problematic, in which case it can be surgically removed if needed). Dermatofibroma can occasionally mimic BCC microscopically (it can cause benign hair follicle growths over it that look like BCC), but the reverse is not true. BCC doesn’t look anything like Dermatofibroma under the microscope. I suppose there could be some rare exception I’m not thinking of but I can’t recall seeing a case like that. Yes a skin biopsy can miss a skin cancer, either because the pathologist didn’t recognize it or because of a technical issue with the biopsy (too small, not deep enough, etc) but this is relatively rare overall in my experience. In general, skin biopsies are a very useful tool for diagnosing skin lesions. All of this is just for general information and it’s not medical advice of course. Please be sure to see your dermatologist to discuss any questions or specific advice related to your own healthcare. Best wishes for good health!

[@annie947]

@@JMGardnerMD thank you so much! ❤

[@bettyadams5032]

Are they small white bumps on the labia minora I have three of them

[@JMGardnerMD]

I don’t believe I’ve ever seen a dermatofibroma show up on the labia in the way you describe. I’ve never heard of clotrimazole (an anti-fungus medication used for fungal skin infections) being used to treat a dermatofibroma (which is a benign skin tumor that has nothing to do with fungus). But I cannot diagnose you or give you official medical advice since I am not your doctor. Please ask your doctor for further clarification and guidance. For myself and my family, I choose to only see a dermatologist when I have a skin problem, as they have the most experience and training in handling skin issues. Best wishes to you for good health.

[@missbrendajoy]

Help! I have like 5 of them developing on the tip of my nose.

[@krncle]

What causes dermatofibroma?

[@AbdullahAbdullah-rd9mm]

What is exactly a storiform pattern?

[@JMGardnerMD]

I’ll try to make a short video about this. Thanks for the idea!

[@bettyadams5032]

Dr gave me a clotrimazole cream for the bumps

[@bettyadams5032]

My Dr said I had dermofibrome I want to make sure

[@jeftegerman2125]

Do dermatofibroma slightly grow up not drastically but minimum. Got it checked my derm said dermatofibroma.. but it tends to itch and have a stingfeeling

[@JMGardnerMD]

Yes dermatofibromas can grow. Sometimes even grow quickly. If it is hurting or bothering you, please tell your dermatologist and ask them about having it removed. Usually small dermatofibroma can be easily removed with a punch or shave biopsy or small excision. Please discuss with your dermatologist so they can figure out what is right for you. Best wishes for health and happiness.

[@jeftegerman2125]

@@JMGardnerMD Is it still cause for concern if it stings? If not I’ll leave it be if it is then I may have it surgically removed..

[@Bratty2paid]

@@JMGardnerMDhi, I notice mines also itches and tings as well. I’m wondering the same thing.. mines have been on my skin since march it’s at 2 1/2mm got it checked by derm said it was dermatofibroma. If it were cellular would it have grown more than 2mm within months? If the itches and sting still there and doesn’t bother me is that a cause of concern still?

[@Bratty2paid]

@@JMGardnerMDI am prone to scarring and keloids so idk if it’s worth removing

[@misterB2231]

Any special pattern for HIV associated dermatofibroma ?

[@JMGardnerMD]

Not that I’m aware of.

[@Jojobreez]

My df came back after a shave.

[@Jojobreez]

Could I freeze this off?

[@JMGardnerMD]

Freezing usually works best for very superficial things near the top of the skin. Dermatofibroma is not usually treated by freezing (liquid nitrogen) as it is too deep to be reached by the freeze. Be sure to see your dermatologist to discuss what treatment options might be best for you if you have a dermatofibroma that you wish to have removed.

[@Jojobreez]

Jerad Gardner, MD if this is the case why do they recommend freezing warts, also why do physicians not just automatically excise them?

[@amaliyadipita6906]

👍🏾👍🏾👍🏾👍🏾👍🏾❤️❤️❤️❤️❤️

[@user-eq2vd6ve6q]

Very very helpful.　　No site like this in Japanese.　　I focused my attention most on this video to follow the explanation. Thank you so much.

[@JMGardnerMD]

A complete organized library of all my videos, digital slides, pics, & sample pathology reports is available here: kikoxp.com/posts/5084 (dermpath) & kikoxp.com/posts/5083 (bone/soft tissue sarcoma pathology).

[@user-eq2vd6ve6q]

@@JMGardnerMD Thank you very much. Very educational. I will see your video on occasions. Arigatougozaimasu.