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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Broken arms, stitches on cheek, hard lump growth, painful and discomfort, dermatofibroma. Done biopsy. What is wrong?

Dear Dr.,
I had a road accident on March 16, 1999 on the way to Roorkee from Hardwar while I was driving myself. The left side cheek was torn and a right forearm bone was broken, resulting in large number of stitches on my cheek (left side of the face).
After a few years of accident, a hard lump was formed on my upper part of the cheek near the scar (at the place of stitches) and it was slowly growing, however there was no pain/itching/discomfort in it. As the hard lump was quite visible, I consulted, Dr. Sanjay Dwivedi, plastic surgeon and Head Plastic Surgery Department, Himalayan Hospital, Jollygrant. He advised to get it removed and he did the surgery to remove this lump on March 03, 2010 (it was after 11 years of the date accident). The discharge slip after surgery and the biopsy report of the removed lump are enclosed for your examination.
Just after about 10 days of operation, I noticed a little hardness near the place of surgery and consulted Dr. Dwivedi. He saw the biopsy report and said surgery wound is recovered; hardness will go away with time. So I also did not bother much for this stiff spot on the face and started using Aloe-vera gel over it as per the Doctor’s advice.
However, I noticed that the hard spot is gradually growing and now it has grown nearly to the same size as it was before surgery. So, I again consulted Dr. Dwivedi on 23-04-13, who again suggested surgery for removal of this lump (prescription enclosed); it is ‘Dermatofibroma’, knowing well as it was reported in biopsy of last removal (three years back). I have also consulted Dr. Praveen Jain (Phone-0000), Plastic Surgeon in Meerut, who also advised surgery without giving any assurance of re-occurrence.
With the hope that probably Homeopathy may give relief. I consulted Homeopath Dr. Vipul Gupta at Delhi, and remained in his treatment from May’13- Aug’13 (4 months) without any visible relief. Presently I’m under the treatment of ayurvedacharya Dr. S K Joshi, Senior Physician & Surgeon at Gurukul Kangri University Haridwar, since July 21st 2013. Still no noticeable recovery, the lump seems to be growing and becoming hard.
Kindly, I need your advice in this case. I wish it is completely diagnosed before any future course of action. Please let me know any suitable doctor and the hospital where I may consult to get it diagnosed.

Thanks, with best regards,
Tue, 12 Nov 2013
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Dermatologist 's  Response
hi. please review the biopsy report with your doctor. It could be dermatofibrosarcoma protuberans. Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue tumor arising in the dermis. It is notorious for high rates of local recurrence despite its low metastatic potential. Although the etiology is unknown, DFSP often is considered to arise within scars and at sites of prior vaccination or trauma. Often DFSP may be misdiagnosed as a keloid, scar or dermatofibroma. Although keloid and scar can be differentated with biopsy the distinction between a dermatofibroma and a more benign appearing DFSP may only be possible by immunohistochemistry
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Broken arms, stitches on cheek, hard lump growth, painful and discomfort, dermatofibroma. Done biopsy. What is wrong?

hi. please review the biopsy report with your doctor. It could be dermatofibrosarcoma protuberans. Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue tumor arising in the dermis. It is notorious for high rates of local recurrence despite its low metastatic potential. Although the etiology is unknown, DFSP often is considered to arise within scars and at sites of prior vaccination or trauma. Often DFSP may be misdiagnosed as a keloid, scar or dermatofibroma. Although keloid and scar can be differentated with biopsy the distinction between a dermatofibroma and a more benign appearing DFSP may only be possible by immunohistochemistry