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Published on: May 7, 2019
[Fibrous papules of the face: a retrospective anatomoclinical study of 283 cases]
1Service de dermatologie, hôpital civil, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France.
Background:
Fibrous papules of the face are frequent benign lesions seen in the nasal and perinasal region. Their clinical aspect is indistinct and the histological signs are sometimes mild or possibly misleading in the case of atypical forms. We carried out a retrospective study of 283 fibrous papules diagnosed at our histology laboratory. The goal of this study was to characterize this type of frequent but occasionally unrecognized lesion.
Patients And Methods:
We performed a retrospective study of fibrous papules of the face diagnosed in the dermatopathology laboratory of our dermatology centre between January 2002 and December 2011. The study concerned the clinical information noted in the examination request and the morphological abnormalities seen at optical microscopy. An immunohistological study of factor XIIIa was performed in selected cases.
Results:
The fibrous papules of the face came from 129 men and 154 women aged between 18 and 90 years (mean: 46 years). Two hundred and thirty-seven (83.7%) lesions were taken from the nasal region and none were taken from anywhere other than the face. The clinically mentioned diagnoses varied. A diagnosis of fibrous papule of the face was stated in 42% of cases, and the main differential diagnoses were nevus (stated in 34% of cases) and basal cell carcinoma (stated in 14% of cases). The fibrous papules were classic in 85.5% of cases. We observed 6 variants of fibrous papule: hypercellular, inflammatory, pleomorphic, pigmented, clear-cell and granular-cell types. Immunohistochemistry of factor XIIIa was positive in all cases except clear-cell fibrous papules.
Discussion:
This study shows that despite their frequency, these lesions often go unrecognized, since the hypothesis of a fibrous papule of the face was mentioned in fewer than 50% of cases at the time of biopsy. Diagnosis is often made by the histopathologist, who may be misled by some rare types. The principal differential diagnoses are nevus and basal cell carcinoma, thus warranting methodical histological analysis of all pieces.
Insights
Fibrous papules of the face are common but frequently unrecognized benign skin lesions. Histopathological analysis is crucial for accurate diagnosis, differentiating them from conditions like nevi and basal cell carcinoma.
Area of Science:
- Dermatopathology
- Dermatology
- Histopathology
Context:
- Fibrous papules of the face are common benign lesions, primarily affecting the nasal and perinasal regions.
- Their clinical presentation can be indistinct, and histological findings may be subtle or misleading, especially in atypical variants.
- A retrospective study analyzed 283 fibrous papules to better characterize these lesions.
Purpose:
- To characterize the clinical and histological features of fibrous papules of the face.
- To assess the diagnostic accuracy of clinical versus histopathological evaluation.
- To identify common differential diagnoses and potential diagnostic challenges.
Summary:
- A retrospective analysis of 283 facial fibrous papules (129 males, 154 females; age 18-90) revealed most lesions (83.7%) were located on the nose.
- Clinical diagnoses were often inaccurate, with "fibrous papule" suggested in only 42% of cases; common differentials included nevus (34%) and basal cell carcinoma (14%).
- While 85.5% were classic, 6 variants were noted, with factor XIIIa immunohistochemistry positive in most, except clear-cell types.
Impact:
- Highlights the frequent underdiagnosis of fibrous papules in clinical settings.
- Emphasizes the critical role of histopathology in accurate diagnosis, particularly for atypical variants.
- Underscores the importance of considering nevus and basal cell carcinoma in the differential diagnosis, necessitating thorough histological examination.
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