Acral Fibrokeratoma at Low Magnification Acral fibrokeratoma is a protuberant, pedunculated lesion covered by a hyperkeratotic, variably acanthotic epidermis.
Superficial Portion of Acral Fibrokeratoma The epidermis overlying acral fibrokeratoma demonstrates thick, compact hyperkeratosis . In the superficial dermis, there may be dilated blood vessels . Note the absence of adnexal structures.
Dermal Spindle Cells in Acral Fibrokeratoma Acral fibrokeratoma is characterized by a relatively hypocellular fibroblastic proliferation and thickened, vertically oriented collagen bundles in the dermis.
Acral Fibrokeratoma at High Magnification High-power examination demonstrates the bland fibroblasts and vertically oriented, thickened collagen bundles.
TERMINOLOGY
Synonyms
• Acquired digital fibrokeratoma
• Acquired periungual fibrokeratoma
• Garlic clove fibroma
• Subungual fibroma of tuberous sclerosis
Definitions
• Benign, dome-shaped, relatively hypocellular mesenchymal tumor that usually presents on digits
ETIOLOGY/PATHOGENESIS
Genetic Syndrome
• Subset of cases associated with tuberous sclerosis
• Mutation of TSC1 or TSC2
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. In the superficial dermis, there may be dilated blood vessels 
. Note the absence of adnexal structures.
in the dermis.
