A 50-year-old man presents to the clinic requesting removal of a growth on his finger. The patient reports that the lesion has been present for over a year and was treated elsewhere with 2 courses of liquid nitrogen spray, which failed to remove the growth. He noted that the growth causes no discomfort and has never bled. The patient is obese and takes metformin for treatment of type 2 diabetes; he uses finasteride electively as a preventative for hair loss. Physical examination reveals a 0.4-cm, flesh-colored papule on the dorsal surface of the fifth finger of his left hand. No similar lesions are noted elsewhere.
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Acquired digital fibrokeratoma is an uncommon fibrous tumor first described in the dermatologic literature in 1968.1 This initial report documented 10 cases occurring on the fingers. The neoplasm, however, has been found at other locations including the lower lip, elbow, and heel; hence the recommendation to drop “digital” from the name.2 A classic lesion is a firm, flesh-to-pink colored papule surrounded by a hyperkeratotic collarette measuring several millimeters in diameter. Men are predominately affected and the growth may arise spontaneously or at a site of trauma.3
The most common histopathologic variant is characterized by a hyperkeratotic and acanthotic epidermis with densely packed collagen bundles containing fine elastic fibers.4 Dermoscopy may highlight the surrounding collarette.5 Spontaneous involution does not occur, therefore, shave or full surgical excision is the recommended treatment modality.
Stephen Schleicher, MD, is director of the DermDox Dermatology Centers, associate professor of medicine at Geisinger Commonwealth Medical College, and clinical instructor of dermatology at Arcadia University and Kings College.
- Bart RS, Andrade R, Kopf AW, Leider M . Acquired digital fibrokeratomas. Arch Dermatol. 1968;97:120-129. doi:10.1001/archderm.1968.01610080024004
- Tabka M, Litaiem N. Acquired digital fibrokeratoma. In: StatPearls [Internet]. StatPearls Publishing; Updated 2022 May 1. https://www.ncbi.nlm.nih.gov/books/NBK545146/
- Freitas PM, Xavier MH, Pereira GB, et al. Acquired fibrokeratoma presenting as a giant pedunculated lesion on the heel. Dermatol Online J. 2008;14(12):10. doi:10.5070/D31tb5c7gq
- 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. doi:10.1111/ijd.14046
- Rubegni P, Poggiali S, Lamberti A, et al. Dermoscopy of acquired digital fibrokeratoma. Australas J Dermatol. 2012;53(1):47-48. doi:10.1111/j.1440-0960.2011.00793.x