Dermatofibroma is a common benign dermal tumour of unknown aetiology. With varied clinical presentation mimicking keloid, desmoid tumour and leiomyoma, the diagnosis of Dermatofibroma sometimes become problematic from the clinician side. Here, we report a case of Dermatofibroma in a not so common site which was clinically diagnosed to be a keloid. But later, the lesion turned out to be a dermatofibroma on histopathological examination. In our patient, the lesion was a single smooth circumscribed nodule over the left side of the abdomen. The lesion had a linear scar on either side and on palpation; it was firm in consistency. It was initially diagnosed to be a keloid which even after multiple intra-lesional steroid injections, failed to show any results. This prompted us to search for an alternate diagnosis; hence lesion was excised and analyzed. The Histopathological examination revealed a circumscribed lesion in the dermis, composed of benign spindle-shaped cells arranged in a storiform pattern. These findings, as mentioned above, were consistent with a diagnosis of Dermatofibroma, which is a slow-growing tumour commonly seen in the extremities. The keloid like a presentation of Dermatofibroma, is one another example of how a similar morphological presentation may have two distinct diagnoses resulting in a delay in providing appropriate treatment.
Nevus comedonicus is an uncommon cutaneous developmental defect of follicular apparatus characterized by unilateral and linear distribution of bundles of dilated hair follicles filled with keratin plugs. It is usually seen on the head and neck region, trunk and upper arm. This condition may be present at birth or can occur later in life. The term nevus comedonicus is a misnomer as there are no true comedones and is better termed as follicular keratotic nevus. It is also known as nevus zoniforme or nevus acneiformis unilateralis. There are two types of nevus comedonicus, namely inflammatory and non-inflammatory (non-pyogenic). When nevus comedonicus is manifested with other extracutaneous symptoms, it is termed as nevus comedonicus syndrome. Diagnosis is mainly clinical, based on history and typical morphology. As the disease runs a benign course, no aggressive treatment is required. Patients seek treatment, especially for cosmetic purposes and inflammatory type of lesions. Various treatment modalities like topical therapy, surgical excision, lasers are available and treatment options are individualized based on the size and extent of the lesion. We herein present a case of unilateral nevus comedonicus with no systemic associations in a 30-year-old female on her lower limb which is not a common site of occurrence.
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