This 53-year-old woman with a history of acquired imminodeficiency syndrome, Hepatitis C virus infection, asthma, hypertension, intravenous drug abuse, and syphilis had a 2 year history of slowly progressive asymptomatic nodules of her lower extremities. A skin biopsy showed the characteristic changes of sclerotic fibroma. Sclerotic fibroma is an uncommon, benign fibrous neoplasm that was first reported in patients with the multiple hamartoma syndrome or Cowden’s disease. It is now clear that sclerotic fibromas can present as a sporadic, small, solitary cutaneous mass in an otherwise healthy individual without Cowden’s disease. However, all reported cases of multiple sclerotic fibromas have been in patients with Cowden’s disease. They can occur anywhere on the body including the head, tongue and buccal mucosa. As in this patient, the characteristic lesion is a firm flesh-colored to whitish nodule.
There is a well-circumscribed, unencapsulated dermal nodule with attenuated overlying epidermis. The tumor is composed of thickened and homogenized eosinophilic collagen bundles arranged in a storiform pattern with intervening prominent clefts.