A 66-year-old man presents for evaluation of a growth on his left palm. He first noted the lesion approximately 1 year ago, and it has increased in size considerably throughout the last 3 to 4 months. Prior treatment with liquid nitrogen was ineffectual. The patient denies any history of arthritis, connective tissue disease, skin cancer, or prior warts. Gripping objects has become impeded due to tenderness. Examination reveals a firm, slightly violacious nodule with a hyperkeratotic core.
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Acquired digital fibrokeratoma is a rare, fibrous tumor that is most commonly found on the fingers but has also been observed on the toes and soles of the feet.1 The condition was first described in 1968.2 Lesions present as firm, flesh-colored papules that are usually asymptomatic. Most lesions are <1cm in diameter, although “giant” lesions (>1cm) have been described and may be painful.3 Trauma has been implicated in the pathogenesis.4 Differential diagnosis includes warts, dermatofibroma, and neurofibroma.
Diagnosis is confirmed by biopsy that reveals a hyperkeratotic and acanthotic epidermis with a variable amount of collagen bundles admixed with elastin fibers.1 Lesions are negative for human papillomavirus expression. Full surgical excision is the treatment of choice and will prevent recurrence.
Stephen Schleicher, MD, is director of the DermDox Center for Dermatology in Pennsylvania, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College.
1. Shih S, Khachemoune A. Acquired digital fibrokeratoma: review of its clinical and dermoscopic features and differential diagnosis. Int J Dermatol. 2019;58(2):151-158.
2. Bart RS, Andrade R, Kopf AW, Leider M. Acquired digital fibrokeratomas. Arch Dermatol. 1968;97(2):120-129.
3. Al-Atif HM. Giant acquired acral fibrokeratoma: a case report. Dermatol Reports. 2019;11(2):8215.
4. Zakopoulou N, Bokotas C, Frangoulis M, Karypidis D, Hatziolou E, Papadopoulos O. Giant tumour of the heel: acquired fibrokeratoma. Clin Exp Dermatol 2009;34(5):605-606.