The patient is a 15-month-old black boy who has had an enlarging mass over the right little finger for five months. The mass began to limit his dexterity during playing. On examination, he had a firm, smooth nodule one cm in width, which extended dorsoradially from the distal interphalangeal joint to the base of the nail of the right little finger (Fig. 1). The mass was neither inflamed nor tender. Otherwise, the physical examination was unremarkable. Clinically, the lesion was considered to represent either a fibroma or a keloid. During the subsequent two months of observation, the nodule doubled in size, and a decision was made to remove it for both diagnostic and therapeutic reasons.
SURGICAL PROCEDURE: Dr. Howard Caplan (Plastic Surgeon)The mass extended from the distal interphalangeal joint out over the nail bed and measured approximately 1 cm X 2 cm in size (Fig. 1). After grossly complete removal of the mass, a split-thickness skin graft was taken from the hypothenar area of the same hand and sutured into place.
PATHOLOGY REPORT: Dr. Harry Kozakewich (Pediatric Pathologist)The surgical specimen was a hemispherical, white, rubbery tumor that measured 1.5 cm in width. It tethered the elevated and stretched dark brown skin. Light microscopy revealed a moderately cellular, fibroproliferative process involving the dermis with compression and elongation of the epidermal rete pegs and sweat glands (Fig. 2). The homogeneous growth extends to the margins of resection. Fibroblast-like cells with plump, Dr. Kozakewich is now at the
