A Slowly Enlarging, Tender Plaque
A Slowly Enlarging, Tender Plaque
A 44-year-old black woman.
The patient presented with a slowly enlarging, tender plaque of more than 1.5 years' duration. She thought it had started out as a small scar from a "pimple." She had a history of keloids that developed in other sites of trauma. This lesion had been diagnosed and treated as a keloid by another physician approximately 6 months previously. She had been advised to apply potent topical steroids and silicone gel sheeting to the lesion. She did this for a few months, but noted that she had difficulty making the gel sheeting adhere to the protuberant portions of the lesion. She observed no response to the treatment, which eventually prompted her to seek further attention from a dermatologist.
The patient presented with a 5.3 x 6.9-cm hyperpigmented plaque with dark brown and pink firm nodules in the midline of her upper abdomen (Figure 1).
(Enlarge Image)
Hyperpigmented plaque with nodules. (Courtesy of Dr. Stasko)
There were sheets of uniform spindled cells in the dermis interlacing in a cartwheel or storiform pattern (Figure 2). These cells also invaded the subcutaneous fat extending between the adipocytes in honeycomb fashion. In other subcutaneous areas, there were multiple layers of spindled cells oriented parallel to the skin surface.
(Enlarge Image)
Histopathology of lesion. (Courtesy of Dr. Stasko)
What is your diagnosis?
View the correct answer.
<p>Dermatofibrosarcoma protuberans</p>
A 44-year-old black woman.
The patient presented with a slowly enlarging, tender plaque of more than 1.5 years' duration. She thought it had started out as a small scar from a "pimple." She had a history of keloids that developed in other sites of trauma. This lesion had been diagnosed and treated as a keloid by another physician approximately 6 months previously. She had been advised to apply potent topical steroids and silicone gel sheeting to the lesion. She did this for a few months, but noted that she had difficulty making the gel sheeting adhere to the protuberant portions of the lesion. She observed no response to the treatment, which eventually prompted her to seek further attention from a dermatologist.
The patient presented with a 5.3 x 6.9-cm hyperpigmented plaque with dark brown and pink firm nodules in the midline of her upper abdomen (Figure 1).
(Enlarge Image)
Hyperpigmented plaque with nodules. (Courtesy of Dr. Stasko)
There were sheets of uniform spindled cells in the dermis interlacing in a cartwheel or storiform pattern (Figure 2). These cells also invaded the subcutaneous fat extending between the adipocytes in honeycomb fashion. In other subcutaneous areas, there were multiple layers of spindled cells oriented parallel to the skin surface.
(Enlarge Image)
Histopathology of lesion. (Courtesy of Dr. Stasko)
What is your diagnosis?
Dermatofibrosarcoma protuberans
Keloid
Dermatofibroma
Desmoid tumor
View the correct answer.
<p>Dermatofibrosarcoma protuberans</p>
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