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3. Kimyai-Asadi A, Goldberg LH, Nemeth A, Friedman PM, et al. Mohs micrographic surgery for elliptical excision of skin tumors: a surgical and histologic study. Dermatol Surg 2004;30:1310–8. 4. Rodriguez FJ, Folpe AL, Giannini C, Perry A. Pathology of peripheral nerve sheath tumors: diagnostic overview and update on selected diagnostic problems. Acta Neuropathol 2012;123: 295–319. 5. Patrizi A, Medri M, Affolter Orlowski F, Misciali C, et al. Myxoid neuroﬁbroma in a child. An asymptomatic nodule on the ﬁnger. Eur J Dermatol 2011;21:267–8.
Diane Trieu, MD Anna Drosou, MD Mary R. Schwartz, MD Leonard H. Goldberg, MD Department of Dermatology Department of Pathology and Genomic Medicine Houston Methodist Houston, Texas
Aneurysmal Dermatofibroma Successfully Treated With Mohs Micrographic Surgery Aneurysmal dermatoﬁbroma (ADF, also referred to as aneurysmal ﬁbrous histiocytoma) is a rare soft-tissue tumor with a local recurrence rate as high as 20% after traditional surgical excision (TSE).1,2 This tumor is also believed to have malignant potential, as there have been several reports of metastasis in the literature.1,3,4 The authors present a case of ADF excised using Mohs Micrographic Surgery (MMS) with 47 months of recurrence-free follow-up.
Case Report A 58-year-old woman was noted to have a 5-mm pink-purple papule on her posterior right calf during a routine skin examination. The patient believed that the lesion had been present for several years but had come to her attention recently because she thought it abruptly became darker. The lesion had bled in the past but was not painful. A 6-mm punch excisional biopsy was taken during the initial encounter.
Figure 1. Aneurysmal dermatofibroma. (A) A 1.5-cm biopsy scar and residual tumor on the posterior right calf before MMS. (B) After Mohs defect. (C) Complex primary closure after MMS.
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Figure 2. Aneurysmal dermatofibroma. Formalin-fixed paraffin-embedded hematoxylin and eosin staining of the tumor showing focal vascularity and hemosiderin deposition.
Pathology at this time demonstrated a cellular ﬁbroma with focal vascularity and hemosiderin deposition, consistent with an ADF. The tumor extended to the surgical margin, and reexcision was recommended. She was referred for MMS at that time with frozensection histopathologic evaluation for clearance of the surgical margins. Mohs micrographic surgery revealed that the tumor was localized to the dermis and required 1 MMS stage for tumor-free margins (Figure 1). There were no complications of surgery. A defect 1.5 · 1.5 cm was closed with complex primary closure using deep interrupted deep sutures and a running epidermal suture. After 4 years of follow-up with a dermatologist, no lesions have appeared at the old surgical site, locally, or elsewhere on the body. A lymph node examination was without abnormalities.
Discussion Aneurysmal dermatoﬁbroma is a rare mesenchymal tumor arising from ﬁbroblast and histiocytic cells in the dermal layer of the skin.4 It is one of several variants of the more common and benign dermatoﬁbroma, although it is histologically and morphologically distinct in its features and behavior. Aneurysmal dermatoﬁbroma most commonly presents on the extremities as a blue, red, purple, or black papule