TELEDERMATOLOGY READER REPORT
HISTORY
Chief complaint: presenting for diagnosis of a lesion.
History of present illness: A 36-year-old man presents with "a brown smooth bump" on his thigh that he states he believes formed after a mosquito bite, 2 years ago. He attempted to squeeze the lesion and noted it disappeared. He does not feel it has changed since he first noticed it. Prior treatment: none. His primary symptom: none. Prior biopsy: none. He has no personal or family history of skin cancer or melanoma. Other significant laboratory/study findings: none.
IMAGE QUALITY ASSESSMENT
Satisfactory with suggestions for improvement. The retraction of the lesion, seen in the image, is an important find; however, provision of an accompanying nonmanipulated lesion would be preferred.
TELEDERMATOLOGY IMAGING READER REPORT
One image was provided that shows an invaginated papule on compression (see Figure 1).
INTERPRETATION OF IMAGES
Lesion A
Findings
The presented lesion and history are most consistent with the diagnosis of a dermatofibroma. Notably, the central depression is consistent with the pathognomic "dimple sign."
RECOMMENDATIONS
Skin Care and Treatment Recommendations
Reassurance.
RECOMMENDED FOLLOW-UP
Type of visit
Return to primary provider for reassurance that this lesion is benign. It is recommended that the patient be reevaluated should there be a significant change in the border, color, shape, or size of the lesion or if it should become symptomatic.
CLINICAL PEARL
Superficial benign fibrous histiocytomas (dermatofibromas) are a common cutaneous lesion that occur more frequently in women, for which the etiology is unknown. They have a predilection for the lower legs and are generally asymptomatic and solitary. In general, removal is not recommended unless they are symptomatic (e.g., pruritic or painful) or if there is diagnostic uncertainty. If the lesion is cosmetically bothersome, it can be removed with an excisional biopsy, which will result in a scar. A shave biopsy can be helpful diagnostically but carries a higher risk of recurrence.
A multiple eruptive variant has been reported in some patients with alteration in their immune status, for example, HIV infection, systemic lupus erythematosus, leukemia, and Crohn's disease, as well as some medications (e.g., antitumor necrosis factor alpha agents; Pierson, 2014).
The standardized teledermatology reader report format is available for authors on the submissions Web site and outlined in Table 1.
REFERENCE