Dermatology Reports 2019; volume 11:8215

Giant acquired acral nificance of any sex predilection of this fibrokeratoma: A case report tumor type. Reported acquired digital fibro- Correspondence: Hend M. Al-Atif, keratoma cases have occurred in patients Department of Internal Medicine, College of from 12 to 70 years of age, with most cases Medicine, King Khalid University, Abha, Hend M. Al-Atif occurring in middle-aged adults.10 Most Saudi Arabia. Department of Internal Medicine, patients with acquired digital fibrokeratoma Tel. +966555211366. E-mail: [email protected] College of Medicine, King Khalid present with an asymptomatic protuberance 11 University, Abha, Saudi Arabia that gradually increases in size over time. 12 Key words: Acquired ; Dupré et al. described this tumor entity is Tumor; Skin lesion; Histopathology; Saudi slightly prominent, well-defined, surround- Arabia. ed by a hyperkeratotic collar, and protrud- ing from the surface of the skin, much like Conflict of interest: the author declares no Abstract a hernia. The pathophysiology of an potential conflict of interest. Acquired acral fibrokeratoma (AAF) is acquired digital fibrokeratoma is unknown. a rare benign fibrous tumor. Its size is usu- Trauma has often been proposed as a pre- Funding: none. ally small (i.e., <0.5 cm). However, few disposing factor for ADFKs, but case histo- 13,14 Ethical statement: written informed consent cases with giant lesions (i.e., >1 cm) have ries have not supported this hypothesis. was obtained from the patient for publication It is presumed that trauma or local factors been reported. A 17-year-old Saudi male of this case report and accompanying images. presented to the Dermatology Outpatient result in an epidermal interaction and the Clinic of Aseer Central Hospital, Aseer development of fibroepithelial tumors. The Received for publication: 21 June 2019. Region, Saudi Arabia, with a painless lesions are usually dome-shaped, although Revision received: 30 September 2019. rounded skin-colored exophytic nodule they may present as elongated finger-like Accepted for publication: 1 October 2019. arising from the dorsal surface of the right projections, as in our case. Herein, we middle toe, 1.7 cm in diameter. The tumor report a case of giant acquired acral fibro- This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 was surgically excised. Histopathology keratoma in a Saudi adolescent male. onlyInternational License (CC BY-NC 4.0). examination revealed a giant polyploid lesion, composed of massive hyperkerato- ©Copyright: the Author(s), 2019 sis, acanthosis, a core of thick collagen bun- Licensee PAGEPress, Italy dles and vertically oriented small dermal Case Report use Dermatology Reports 2019; 11:8215 blood vessels. The diagnosis was giant doi:10.4081/dr.2019.8215 AAF. There was no evidence of recurrence In April 2015, a 17-year-old Saudi male after surgical excision. AAF is a rare benign presented to the Dermatology Outpatient skin tumor which should be differentiated Clinic of Aseer Central Hospital, Aseer from other similar skin lesions. Surgical Region, Saudi Arabia, with a painless Discussion excision is the first line for treatment. rounded skin-colored lump at the dorsum of his right middle toe. The tumor started four Our patient was a Saudi male adoles- months earlier as a very small lesion, but cent, who presented with a spontaneous, slowly increased in size until it became a painless, solitary tumor at the right middle toe that has been progressively growing for Introduction source of social embarrassment and person- al inconvenience during wearing his shoes. the past four months to reach a relatively Acquired acral fibrokeratoma (AAF) is The patient denied exposure to any associ- large size (more than one cm). This present- a rare benign fibrous tumor. It occurs as a ated direct trauma to the toes, and he did not ing picture of AAF is by that reported by 15 solitary lesion, mainly in adults.1 Since its receive any treatment for the lesion. Baykal et al., who stated that AAF is most frequent locations are the fingers and Moreover, there were no similar skin almost always solitary, mostly seen in toes, it was commonly termed acquired dig- lesions in the patient’s family. By clinical adults, with a slight male predominance. ital fibrokeratoma (ADFK), althoughNon-commercial it may examination, there was a skin-colored exo- Despite being not painful or tender, AAF in also affect the palms and the heels.2,3 In phytic rounded nodule arising from the dor- our patient was a cosmetic problem and cases with AAF, the size of the lesion is usu- sal surface of the right middle toe, 1.7 cm in became more annoying to him while wear- ally small (i.e., <0.5 cm). However, few diameter (Figure 1). The patient did not ing shoes as it increased in size. This is in cases with giant lesions (i.e., >1 cm) have have any other similar lesions. There were accordance with that reported by Bron et 5 been very rarely reported in the literature.4-8 no associated chronic diseases or infections. al. who noted that AAF is more a cosmeti- The differential diagnosis for AAF includes The tumor was surgically excised. cally bothersome than a problematic lesion. garlic-clove , Bowen’s disease, Histopathology examination revealed a However, patients with giant AAF on the exostosis keloid, dermatofibrosarcoma, giant polyploid section, composed of mas- dorsal surface of their foot may report some eccrine poroma, neurofibroma, corn sive hyperkeratosis, acanthosis, with a core discomfort. (clavus), cutaneous horn, infantile digital of thick collagen bundles and vertically ori- The patient denied any history of trau- , pyogenic granuloma, ungual ented small dermal blood vessels (Figure 2). ma to the toes associated with his tumor. and subungual fibroma, verruca, and super- Therefore, based on clinical and histopatho- Nevertheless, Jaiswal and Chatterjee16 numerary digit.9 logical findings, the patient was diagnosed noted that trauma seems to be a contributing ADFKs seem to have a slight male pre- as a case of giant acquired acral fibroker- factor to AAF. The diagnosis of our dominance. However, very few cases have atoma. There was no evidence of recurrence patient’s lesion was based upon both clini- been described to adequately assess the sig- for three years after surgical excision. cal and histopathological findings. The

[Dermatology Reports 2019; 11:8215] [page 37] Case Report

Conclusions In conclusion, AAF is a rare benign skin tumor which should be differentiated from other similar skin lesions. Awareness of pri- mary care and family physicians should be raised toward the recognition and referral of patients with this tumor. Surgical excision is the first-line treatment of this benign tumor.

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14. Kint A, Baran R, De Keyser H. Dermatol Venereol Leprol 2002;68: excision of acquired periungual fibro- Acquired (digital) fibrokeratoma. J Am 179-80. keratoma using bilateral proximal nail Acad Dermatol 1985;12:816-21. 17. Shih S, Khachemoune A. Acquired dig- fold oblique incision for preserving nail 15. Baykal C, Buyukbabani N, Yazganoglu ital fibrokeratoma: review of its clinical matrix. Dermatol Surg 2010;36:139-41. KD, et al. Acquired digital fibroker- and dermoscopic features and differen- atoma. Cutis 2007;79:129-32. tial diagnosis. Int J Dermatol 19. Vinson RP, Angeloni VL. Acquired dig- 16. Jaiswal AK, Chatterjee M. Acquired 2019;58:151-8. ital fibrokeratoma. Am Fam Physician (digital) fibrokeratoma. Indian J 18. Lee CY, Lee KY, Kim KH, et al. Total 1995;52:1365-7.

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