Clinical Challenge: Red Bump on Nose -

Clinical Challenge: Red Bump on Nose

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A 28-year-old women presents for evaluation and requests removal of a growth on her nose for cosmetic reasons. The lesion has been present for at least 4 years and has remained asymptomatic. She states that her mother has a similar lesion on her nose but it is flesh colored. Examination reveals a firm, nonblanchable 0.3cm hyperpigmented papule of her right nares. Scattered nevi are noted elsewhere on her body.

The papule was removed by shave excision and histopathology revealed a fibrous papule. Fibrous papules are solitary, benign lesions that most commonly arise on or about the nose. They fall under the spectrum of cutaneous angiofibromas that can appear anywhere...

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The papule was removed by shave excision and histopathology revealed a fibrous papule. Fibrous papules are solitary, benign lesions that most commonly arise on or about the nose. They fall under the spectrum of cutaneous angiofibromas that can appear anywhere on the body, which include pearly penile papules and Koenen tumors (periungual fibromas).1

Fibrous papules are dome-shaped and often shiny. They range in size from 1 to 5 mm and most are flesh-colored to erythematous in hue. They are found in equal frequency among men and women and usually arise by middle age. Fibrous papules are often misdiagnosed clinically as nevi or basal cell carcinomas.2

The diagnosis of fibrous papules is confirmed by biopsy and histology. Histopathology reveals a fibrous stroma replete with fibroblasts along with dilated blood vessels. Similar to cutaneous hamartomas associated with tuberous sclerosis (adenoma sebaceum), stromal cells are spindle to stellate-shaped and are associated with multinucleated giant cells and proliferative thin-walled vessels with dilated lumina.3 In distinction, fibrous papules are sporadic, solitary, and not associated with internal disease whereas tuberous sclerosis is an autosomal dominant inheritance disorder that involves not only the skin but also the central nervous system, heart, and kidneys.3

Fibrous papules are readily removed by shave excision; carbon dioxide (CO2) laser ablation may also be curative.4

Stephen Schleicher, MD, is director of the DermDox Center for Dermatology in Pennsylvania, as well as associate professor of medicine at Commonwealth Medical College and clinical instructor of dermatology at Arcadia University and Kings College.   

References

1. Macri A, Kwan E, Tanner LS. Cutaneous angiofibroma. In: StatPearls [Internet]. StatPearls Publishing; 2020 Sep 15.  Accessed April 15, 2021. https://www.ncbi.nlm.nih.gov/books/NBK482470/

2. de Cambourg G, Cribier B. [Fibrous papules of the face: a retrospective anatomoclinical study of 283 cases]Ann Dermatol Venereol. 2013;140(12):763-770. doi: 10.1016/j.annder.2013.09.163

3. Chan JYL, Wang KH, Fang CL, Chen WY. Fibrous papule of the face, similar to tuberous sclerosis complex-associated angiofibroma, shows activation of the mammalian target of rapamycin pathway: evidence for a novel therapeutic strategy? PloS One.  201418;9(2):e89467. doi: 10.1371/journal.pone.0089467

4.  Ali FR, Mallipeddi R, Craythorne EE, Sheth N, Al-Niaimi F. Our experience of carbon dioxide laser ablation of angiofibromas: case series and literature reviewJ Cosmet Laser Ther. 2016;18(7):372-375. doi: 10.1080/14764172.2016.1197403