Figure - available from: Skin Appendage Disorders
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a From underneath the PNF, a wide ADFK is seen, a medial section of which was removed for histology. b An ADFK with a wide discrete trough on the ventral nail. c A triangle-shaped ADFK with a wide base hidden beneath the PNF. d A wide ADFK only fully visible after reflection of the PNF.
Source publication
Acquired digital fibrokeratoma (ADFK) is a benign tumor. Clinically, it usually presents as skin-colored, slow-growing firm fibrous projection with a characteristic hyperkeratotic collarette at its base. It has a predilection for the periungual tissue. Some clinical variations have been described according to its macroscopic appearance and relation...
Citations
... The protruding skin surfaces exhibit exophytic growth, the base can be contracted, and collar-shaped bulges can be seen on the periphery. 4 ADF is slow-growing, without any subjective symptoms, and there is no evidence of spontaneous resolution. ADF lesions are usually less than 1 cm in diameter; ADF lesions with a diameter >1 cm are called giant ADFs. 5 For the patients in this study, the mean age was 42.6 years, which is approximately the same as that reported in the literature. ...
Acquired digital fibrokeratoma (ADF) is rare in clinical practice and is easily misdiagnosed. Herein, 5 cases of patients (3 males and 2 females) with ADF are reported. The mean age at onset was 42.6 years, and the mean disease duration was 3 years. Four patients had ADF on the hands, and 1 patient had ADF on the foot. The clinical manifestations were all solitary, skin-colored papules, with a firm texture and smooth surface, protruding from the skin surface. In 3 patients, ADF manifested as columnar protrusions, and in 2 patients, ADF manifested as dome-shaped protrusions. For all 5 patients, the diameters of the lesions were <1 cm. Clinically, all 5 patients were misdiagnosed (ie, eccrine poroma (EP), common warts, rudimentary polydactyly, pyogenic granuloma (PG), and acral fibroma). All cases of ADF were confirmed by histopathology. The histopathological manifestations of ADF were as follows: finger-like protrusions on the skin surface; collagen fiber bundles running vertically to the epidermis seen in the dermis; and thick red-stained collagen fibers connected with the normal dermal connective tissue below. All 5 patients underwent surgical resection; the distance between the incision margin and the edge of the tumor was 2–3 mm, and the surgical depth was the deep dermis. No recurrence was observed in more than half a year of follow-up after surgery.
... The tumor morphology has been reported by various authors as finger-like projections, small plateaulike elevations, spherical mounds, or pedunculated, verrucous or dome-shaped papules with central depression 1,3,16,19 . An unusual case series of four cases with flat-pan nail-wide epiungual ADFK was described by Lencastre et al 13 . ...
Acquired digital fibrokeratoma (ADFK) is a rare benign fibrous
tissue tumor that occurs over the extremities, predominantly in
the periungual area. We report a case of ADFK over the digit
of the right hand presenting as a finger-like growth; the base of
the lesion showed a collarette of scales. The lesion was excised
with ablative CO2 laser. The histopathology was typical, showing
hyperkeratosis and acanthosis. The core of the lesion had abundant
collagen fibers perpendicular to the long axis of the epithelium.
There was good healing with minimal scarring; the patient was
followed up, and no recurrence was reported more than one
year later. ADFK is a relatively rare tumor, with less than 150
cases reported worldwide; we present a concise review of the
published ADFK cases with their clinical and histopathological
characteristics. To the best of our knowledge, this is the seventh
such case to be reported from India.
... However, few cases with giant lesions (i.e., >1 cm) have been very rarely reported in the literature. [4][5][6][7][8] The differential diagnosis for AAF includes garlic-clove fibroma, Bowen's disease, exostosis keloid, dermatofibrosarcoma, eccrine poroma, neurofibroma, corn (clavus), cutaneous horn, infantile digital fibromatosis, pyogenic granuloma, ungual and subungual fibroma, verruca, and supernumerary digit. 9 ADFKs seem to have a slight male predominance. ...
Acquired acral fibrokeratoma (AAF) is a rare benign fibrous tumor. Its size is usually small (i.e., <0.5 cm). However, few cases with giant lesions (i.e., >1 cm) have been reported. A 17-year-old Saudi male presented to the Dermatology Outpatient Clinic of Aseer Central Hospital, Aseer Region, Saudi Arabia, with a painless rounded skin-colored exophytic nodule arising from the dorsal surface of the right middle toe, 1.7 cm in diameter. The tumor was surgically excised. Histopathology examination revealed a giant polyploid lesion, composed of massive hyperkeratosis, acanthosis, a core of thick collagen bundles and vertically oriented small dermal blood vessels. The diagnosis was giant AAF. There was no evidence of recurrence after surgical excision. AAF is a rare benign skin tumor which should be differentiated from other similar skin lesions. Surgical excision is the first line for treatment.
Background:
Acquired ungual fibrokeratomas (AUFKs) are benign recurrent fibrokeratotic tumors of the nail unit of uncertain etiology. Little is known about the optimal modality to successfully treat these lesions. No systematic review addressing ungual fibrokeratomas has been published to date.
Objectives:
The aim of this study is to summarize all the published data regarding diagnostic and therapeutic challenges of AUFKs.
Methods:
On August 9, 2019, a systematic search of Medline and Cochrane databases was conducted. All the studies describing the treatment of ungual fibrokeratomas, procedure description, pathological findings, outcome, and follow-up period were included in this review.
Results:
After full-text article review, 103 articles were included, representing a total of 78 lesions. The commonly used treatments for fibrokeratomas were complete tumor resection (90.5%), shave excision (8.3%), and cryotherapy (1.2%). Complete surgical excision yielded the highest cure rate among all treatment modalities (90.8%) compared to partial surgical excision (28.6%) and cryotherapy (0%). The mean follow-up period was 12.1 months (1-144).
Conclusion:
Complete surgical removal preserving the matrix showed the highest cure rates and should be considered as first-line treatment for AUFKs. Future adequately designed randomized control trials are warranted to compare different treatment modalities.
