Keloidal dermatofibroma: report of 10 cases of a new variant

Dermatofibroma is a common cutaneous tumor. Unusual variants of dermatofibroma that exhibit various epidermal changes or different cellular composition have been described. We observed 10 cases of a novel variant of dermatofibroma characterized by keloidal change within the tumor. Formalin-fixed, paraffin-embedded tissues were used for histochemical and immunohistochemical studies. The patients consisted of six women and four men; median age was 34 years (17 to 59 years). All tumors occurred on the extremities, and six were present for at least 2 years. Tenderness was mentioned in four cases. They were described as erythematous or brown papules 1 cm or smaller. Clinical appearance did not deviate from that of ordinary dermatofibromas. Microscopically, the excised tumors showed a superficial circumscribed area of keloidal change under an atrophic epidermis in an otherwise ordinary dermatofibroma. In the keloidlike area, multinucleated giant cells, hemorrhage, hemosiderin deposits, and scattered KiM1P-positive histiocytes, but not factor XIIIa-positive or CD34-positive cells were present among the thick collagen fibers. There were no known recurrences. This variant dermatofibroma should not be overlooked as a simple keloidal scar. The observation of keloidal change in dermatofibromas may support the connotation that trauma is a possible cause of dermatofibroma. The fact that Asian people are more prone to develop keloid may have led us to find this new variant.