When to refer

Dermatofibromas are benign and most are confidently identified. But certain situations warrant a lower threshold for further evaluation.

When the classic pattern is incomplete

The classic pattern — central white patch with peripheral network — should be clearly present for confident identification. If you can see only pigment network without a white centre, or a white area without surrounding network, the pattern is incomplete. An incomplete pattern does not exclude dermatofibroma, but it means you cannot confirm it with high confidence either.

When the lesion is growing

Dermatofibromas are stable. They may develop slowly initially, but once established, they do not change significantly. A firm nodule that is actively growing — even slowly — does not behave like a dermatofibroma and deserves further assessment.

When the location is atypical

While dermatofibromas can appear anywhere, the vast majority occur on the lower legs and, to a lesser extent, the upper arms. A firm, pale nodule on the head, neck, or trunk is in atypical territory for dermatofibroma. This is where desmoplastic melanoma enters the differential — maintain a lower threshold for referral.

When there are multiple new dermatofibromas

Having several dermatofibromas is common and generally benign. But the sudden appearance of multiple new dermatofibromas can occasionally be associated with immunosuppression or, rarely, systemic conditions. If a patient develops numerous new dermatofibromas over a short period, consider the broader clinical picture.