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September 2010

Dome-Shaped Papule on the Posterior Shoulder—Diagnosis

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Arch Dermatol. 2010;146(9):1037-1042. doi:10.1001/archdermatol.2010.215-b

Histopathologic examination of the biopsy specimen demonstrated a circumscribed dermal tumor composed of pleomorphic spindled and multinucleate cells within a myxoid stroma. A diagnosis of myxoid cutaneous pleomorphic fibroma was made. To date (after 9 months), the patient has not had a recurrence since shave biopsy.

Myxoid cutaneous pleomorphic fibroma is an uncommon cutaneous tumor characterized by cytologic atypia, but with benign clinical behavior. Pleomorphic fibromas were originally described by Kamino et al in 1989,1 and, although the tumors are likely underreported, fewer than 20 cases have been reported since that time.29 They present as dome-shaped or polypoid, solitary, slow-growing, asymptomatic lesions. They have been reported to occur on the extremities, head, trunk, digital tendon sheath, eyelid, and subungual location and are most frequently seen in middle-aged individuals.

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