A 47-year-old woman requests evaluation for a growth on her nose. The growth is asymptomatic and has been present for approximately 1 year. Her medical history is positive for basal cell carcinoma of her cheek that was removed surgically 5 years ago. She is concerned that the new lesion is cancerous. Examination of the affected area reveals a 0.15-cm slightly erythematous papule.
Submit your diagnosis to see full explanation.
A fibrous papule is a firm lesion that arises on the face, most commonly on the nose. The lesions are dome-shaped and range in size from 1 to 5 mm. The majority are flesh colored to slightly erythematous. Both sexes are equally affected, and the condition occurs primarily in middle-aged persons.
Fibrous papules were originally thought to be derived from nevus cells. It is now known that the cells are in fact fibrohistiocytes that stain positive for factor XIIIa.1 The lesions thus resemble tuberous sclerosis complex-associated angiofibroma, although that disease is characterized by the presence of multiple lesions.2
The differential diagnosis includes basal cell carcinoma, which characteristically enlarges slowly and eventually ulcerates. Fibrous papules are benign lesions. Untreated lesions persist for life and are often cosmetically unacceptable because of their facial location. Shave excision is standard therapy; lesions may also respond to laser ablation.3
Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He practices dermatology in Hazleton, Pennsylvania.
- Nemeth AJ, Penneys NS, Bernstein HB. Fibrous papule: a tumor of fibrohistiocytic cells that contain factor XIIIa. J Am Acad Dermatol. 1988;19:1102-1106.
- Chan JY, 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. 2014;9:e89467.
- Ali FR, Mallipeddi R, Craythorne EE, Sheth N, Al-Niaimi F. Our experience of carbon dioxide laser ablation of angiofibromas: case series and literature review. J Cosmet Laser Ther. 2016 Aug 5:1-4. [Epub ahead of print]