Recurrence Risks After Dermatofibroma Excision

Could you please provide information regarding the recurrence of dermatofibromas after excision?

Hello, Doctor! I apologize for the interruption, but I have a personal situation I would like to inquire about.
I'm not sure if I need to seek medical attention again or undergo another procedure.
At the beginning of last year, I had surgery at the hospital to remove two dermatofibromas, both under 1 cm.
One of them had a cyst inside, and I also had a brown, firm lesion removed from my back (this is the one I am mainly asking about today).
The pathology report from the lesion on my back mentioned, "the dermis shows a small ill-defined, tan and firm lesion," "proliferation of fibrohistiocytes embedded in collagen bundles.
No obvious nuclear atypia or mitoses can be found.
The overlying epidermis reveals reactive hyperplasia and hyperpigmentation."
Now, nearly a year later, the area on my back where the surgery was performed has a brown ring (not as deep as before the removal).
When I touch it, one half feels slightly raised and firmer than the surrounding skin, while the other half feels like it is empty beneath the skin and can be depressed with my finger.
I would like to know if this is considered a recurrence that requires further medical evaluation.
Thank you!

Yang, 30~39 year old female. Ask Date: 2023/02/23

Dr. Wu Yuxin reply Dermatology

It is recommended to discuss this issue further with the original surgeon, as I have not seen the actual skin lesions.

Reply Date: 2023/02/23

More Info

When it comes to dermatofibromas, understanding the recurrence risks after excision is crucial for patients who have undergone surgery. A dermatofibroma is a benign skin tumor that typically appears as a firm, raised bump on the skin, often brownish in color. While these growths are generally harmless, they can be bothersome for cosmetic reasons or if they become irritated.

In your case, you mentioned that you had two dermatofibromas excised, one of which had a cyst inside. The pathology report indicated a proliferation of fibrohistiocytes, which is characteristic of dermatofibromas, and noted no significant atypia or mitotic activity, suggesting that the lesion was benign. However, the presence of reactive hyperplasia and hyperpigmentation in the overlying epidermis indicates that there was some response from the skin following the excision.

After excision, dermatofibromas can recur, although the rate of recurrence is generally low. Factors that may influence recurrence include the completeness of the excision, the size of the lesion, and individual patient factors such as skin type and healing response. In your situation, the area where the dermatofibroma was removed has developed a brownish discoloration and a change in texture, with part of it being firmer and raised while another part feels empty and can be depressed with pressure.

The changes you are observing could be due to several factors:
1. Scar Formation: After any surgical procedure, the body forms scar tissue. This can sometimes feel different from the surrounding skin and may appear discolored. The firmness you feel could be a result of scar tissue formation.

2. Recurrence: While it is possible for a dermatofibroma to recur, the characteristics of the lesion you describe (firmness and depression) may not necessarily indicate a recurrence. It is essential to differentiate between scar tissue and a new or recurring lesion.

3. Post-Surgical Changes: The skin can undergo various changes after surgery, including hyperpigmentation and texture changes. These can take time to resolve and may not indicate a problem.

Given the changes you are experiencing, it would be prudent to consult with a dermatologist. They can perform a physical examination and, if necessary, conduct further imaging or a biopsy to determine whether the lesion is a recurrence of the dermatofibroma or simply a post-surgical change.
In summary, while the risk of recurrence exists, the symptoms you describe could also be attributed to normal healing processes or scar formation. A follow-up appointment with your dermatologist is advisable to ensure proper evaluation and peace of mind. They can provide tailored advice based on your specific situation and help you understand the best course of action moving forward.

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