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Abstract: Patient Qian, 39 years old, presented with a left upper arm swelling for more than 5 years, which started as a rice-grain size and then gradually increased in size, recently accompanied by pain. The cause of the dermatofibroma was unknown. After surgical excision, the disease was cured and the dermatofibroma disappeared.
Basic information】Male, 39 years old
Disease Type】Fibroma (dermatofibroma)
Hospital】The Second Hospital of Zhejiang University School of Medicine
Date of consultation】January 2022
Treatment plan】Surgical treatment (dermatofibroma excision)
Treatment Period】Outpatient surgical treatment, stitches removed 2 weeks after surgery
Results】Cured dermatofibroma
I. Initial consultation
Patient Qian, 39 years old, with normal body shape and good nutrition. He reported that a rice-grain-sized swelling appeared on his left arm 5 years ago, which was not accompanied by pain or itching. In the past 2 years, the size of the swelling did not change significantly. Recently, the swelling began to be painful and there was pain on pressure.
The patient was asked about his previous physical health, history of penicillin allergy, and normal diet and sleep since the onset of the disease. Physical examination of the patient showed a soy-sized swelling on the left upper arm with clear borders, which was moderately hard and smooth to the touch. Further dermoscopic examination showed a homogeneous yellow center with a brown pigmented network at the periphery.
II. Treatment
After discussion with the patient, it was decided to give surgical excision of dermatofibroma for treatment, and the consent form for surgery and anesthesia was signed. The patient was given local infiltration anesthesia, a pike incision was made at the edge of the swelling to remove the swelling, and some pathological tissues were taken for laboratory tests.
III. Treatment results
The patient’s preoperative symptoms of a soy-sized swelling and pain in the left upper arm completely disappeared after the dermatofibroma excision surgery. The dermatofibroma surgery was simple and could be performed on an outpatient basis. The patient had good intraoperative anesthesia and no active bleeding. 4 hours after surgery, pain at the wound site appeared, but was tolerable, and the pain gradually decreased, and the wound did not show significant redness and swelling. Pathological results 1 week after surgery showed that the resected material was a spindle cell hyperplasia in the dermis, which was a dermatofibroma change. When the patient went to the hospital for review 2 weeks after the operation, the wound was dry and healed well, and there was no blood or fluid oozing from the wound, so the stitches were removed.
IV. Precautions
The patient was completely cured after dermatofibrosarcoma excision, and I was sincerely happy for the patient. However, since the patient went back to recuperate after the outpatient treatment, the following points still need to be noted in daily life.
1. the patient needs to be instructed to change the dressing on time every day to avoid infection at the wound site and also to observe the wound situation.
2, during the wound healing period need to pay attention to local dryness, avoid contact with water, while diet as far as possible to choose light food, avoid stimulating food, so as not to affect the wound healing;.
3. Patients need to avoid strenuous exercise on the affected arm within 3 months after the stitches are removed, and they can also choose to apply local scar removal drugs to avoid scar formation.
V. Personal insight
Dermatofibrosarcoma is a benign disease that rarely deteriorates, so there is usually no need to worry. If there is no obvious symptom, you can choose to observe it and no special treatment is needed. However, if there are obvious painful symptoms like the patient in this case, surgical excision is an option, and the procedure is relatively simple and the patient does not need to worry about it.