Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2022;12(3):e202297 1

A Solitary Nodule Over the Chest
Gitesh Sawatkar1, Nisha Meshram2, Keshavamurthy Vinay3

1 Department of Dermatology and Venereology, All India Institute of Medical Sciences (AIIMS), Nagpur, India

2 Department of Pathology, All India Institute of Medical Sciences (AIIMS), Nagpur, India 

3 Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research; Chandigarh, India

Citation: Sawatkar G, Meshram N, Vinay K. A solitary nodule over the chest. Dermatol Pract Concept. 2022;12(3):e202297.  
DOI: https://doi.org/10.5826/dpc.1203a97

Accepted: October 26, 2021; Published: July 2022

Copyright: ©2022 Sawatkar et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing interests: None.

Authorship: All authors have contributed significantly to this publication

Corresponding author: Dr. Keshavamurthy Vinay, Department of Dermatology, Venereology and Leprology Postgraduate Institute of 
Medical Education and Research, Sector 12, Chandigarh 160012, India. Tel: +91-8872993222 E-mail: vinay.keshavmurthy@gmail.com

Case Presentation 

A 35-year-old male presented with an asymptomatic, 

 subcutaneous mass with an overlying firm, red-brown 

 nodule and shiny stretched skin (Figure 1A). On  dermoscopy, 

an  accentuated pigment network over background of 

pinkish color was seen. A few structureless focal white ar-

eas were present (Figure 1B). Histopathology revealed a 

poorly  circumscribed dermal tumor with a clear grenz zone. 

The  tumor consisted of monomorphic spindle cells with 

 elongated hyperchromatic nuclei arranged in fascicles form-

ing a storiform pattern (Figure 1C). Clinical, dermoscopic 

and histopathological features confirmed the diagnosis of 

dermatofibrosarcoma protuberans (DFSP).

Teaching Point 

Dermatofibrosarcoma protuberans presents as an asymp-

tomatic, slowly progressive indurated plaque that subse-

quently develops nodules. Dermoscopic features suggestive 

of DFSP are: delicate pigment network, vessels, structureless 

light brown areas, shiny white streaks, pink background col-

oration, and structureless hypo- or depigmented areas [1]. 

Mohs micrographic surgery remains the treatment of 

choice.  Imatinib and sorafenib can be employed for unre-

sectable and metastatic DFSP [2]. This report reinstitutes the 

importance of keen clinical and dermoscopic examination 

with histopathological correlation for timely diagnosis of 

this dermal tumor. 



2 Image Letter | Dermatol Pract Concept. 2022;12(3):e202297

References

1. Bernard J, Poulalhon N, Argenziano G, Debarbieux S, Dalle S, 

Thomas L. Dermoscopy of dermatofibrosarcoma protuberans: 

a study of 15 cases. Br J Dermatol. 2013;169(1):85-90. DOI: 

10.1111/bjd.12318. PMID: 23496114.

2. Allen A, Ahn C, Sangueza OP. Dermatofibrosarcoma Protu-

berans. Dermatol Clin. 2019;37(4):483-488. DOI: 10.1016/j.

det.2019.05.006. PMID: 31466588.

Figure 1. (A) Red-brown nodule with overlying shiny stretched skin present over right side of chest. (B) Dermatoscopy (DermLite™ 

DL3 - 3Gen under contact polarized mode) showing pinkish red  background and unfocussed vessels (yellow arrow), accentuated pigment 

 network (green arrowhead) and focal white areas (black arrow head). (C) Sections shows epidermis with grenz zone and underlying 

 dermal tumor in storiform pattern. Entrapped adnexal structure and adipose tissue seen (H&E, 4x).