TELEDERMATOLOGY READER REPORT1
History
Chief complaint
Presenting for diagnosis of a skin lesion and potential treatment options.
History of present illness
A 56-year-old man presents with "a growth" [primary lesion] on the left index finger [location] that he states has only been present for 1 year [duration]. Prior treatment: none. His primary symptom: pain when the growth gets bumped or caught on objects. Prior biopsy: none. He has no personal or family history of skin cancer or melanoma. Other significant laboratory/study findings: none.
Image Quality Assessment (Evaluation of Image Quality by Teledermatology Provider)
Fully satisfactory. (Evaluator picks one: fully satisfactory/marginal satisfactory with suggestions for improvement/unsatisfactory.)
TELEDERMATOLOGY IMAGING READER REPORT
One image was provided that demonstrates a skin-colored, firm, finger-like protrusion with a collarette of raised skin around the base of the lesion involving the ventral left index finger (Figure 1).
INTERPRETATION OF IMAGES
Lesion A
Findings
The presented lesion and history are most consistent with a diagnosis of acquired digital fibrokeratoma (DFK).
RECOMMENDATIONS
Skin Care and Treatment Recommendations
Present to dermatology for excisional biopsy.
RECOMMENDED FOLLOW-UP
Type of Visit
Refer to dermatology clinic for evaluation (face-to-face) and simple excision. (For the type of visit, completing teledermatology provider picks one: return to primary provider for treatment/refer to dermatology clinic for evaluation (face-to-face)/lesion is benign, recommend reassurance and follow-up as needed [PRN].)
CLINICAL PEARL
Acquired DFK is an uncommon benign growth on the finger with distinct histologic findings that differentiate this growth from such similar-appearing lesions as cutaneous horns, verrucae, supernumary digits, and periungual fibromas (Baykal, Buyukbabani, Yazganoglu, & Saglik, 2007; Satter, 2014; Yu & Morgan, 2013). Because these lesions have also been described on the hands, toes, and soles and once in the prepatellar region since initially defined, they are commonly also referred to as acral fibrokeratomas. Lesions may be papular or nodular with either a flat-topped appearance or, as in this case, an exophytic finger-like appearance. A collarette of raised skin surrounding the base of the lesion is characteristic.
Acquired DFKs are thought to occur after trauma to the affected area, although many patients do not recall a significant traumatic event. A precise etiology has not yet been described. They are not malignant or otherwise dangerous; however, because of their location in areas of frequent friction or pressure and thus bothersome nature, they may be removed simply with shave excision.
Of note, regarding the above and other dermatologic presentations, if a lesion starts to grow, changes suddenly in appearance, or becomes symptomatic, the patient should be referred to dermatology for a face-to-face evaluation.
REFERENCES