(Fibroma molluscum; Molluscum simplex; Molluscum pendulum)
Definition. – A connective tissue new-growth characterized by one or more sessile or pedunculated, soft or firm, rounded, painless tumors in the corium and subcutaneous tissue, varying in size from a hempseed to a cherry or larger.
Symptoms – This condition presents great variety as to size, shape and number. Commonly fibroma is a multiple manifestation, but it may appear as a single, pedunculated tumor which often reaches a large size and become pendulous (fibroma pendulum). In some cases in which these fibromata are numerous, they seem actually to crowd the surface. In such cases they assume a more or less rounded shape and are usually sessile but occasionally appear pear-shaped because of a tendency to narrow at their base. The skin overlying these growths may be normal, pink or reddish color, and may be stretched, hypertrophied or atrophied. Partial or total absorption may take place leaving a softened mass of pendulous hypertrophied skin (dermatolysis). Rarely these larger growths undergo ulceration and even gangrene. Neurofibroma coexist, no doubt, in some cases and occasionally all the lesions are of this character. Any portion of the skin may be involved but multiple growths usually favor the trunk, while the scalp and head are frequently the seat of individual tumors. The palms and soles are rarely involved and then the growths are usually small and flat. Hard fibroma or desmoids, in contradistinction to the soft type or those already described, appear invariably as small solid growths, usually single and pea- sized. All fibromata are freely movable and are usually painless.
Fig. 128 – Multiple fibroma. Hundreds of tumors of varying size, mainly on the trunk.
Etiology and Pathology. – The causes are obscure, although hereditary and family tendencies have been noted in some instances. Both sexes and all nationalities have been afflicted, but in our country, while the condition is not common, the negro race furnishes a large number of cases. A certain degree of mental and physical weakness has been noted in some of these cases. The condition may develop at any age but usually begins in childhood and is rarely congenital. The growth is due to a hyperplasia of the connective tissue although what gives rise to this condition is unknown. When the tumors are neurofibromata, there is naturally an increase in the connective tissue nerve sheaths followed by a similar proliferation in the glandular and vascular structures.
Fig. 129 – Fibroma pendulum which has slowly grown for years, is freely movable, painless and hard (courtesy of Dr. W.H. Bishop).
Diagnosis. – Lipomata are rarely present in numbers, never pedunculated, commonly lobular and somewhat flattened. Neuromata will show active pain. Molluscum contagiosum presents fewer and smaller growths, usually about the eyelids, having a central depression or aperture and are usually superficially situated. Multiple sarcomata are comparatively rapid in their growth, have a red surface and often break down. Moles are usually small, few in number, more or less pigmented and present a smooth surface. Sebaceous tumors (wens) are rarely numerous, not pedunculated and their contents may be expressed after incision.
Prognosis and Treatment. – Life is not endangered by this disease but the growths are persistent and usually increase in size and number. Surgical measures are indicated, such as ligaturing, galvanocauterization or excision depending upon the size, location and nature of the tumors. If the small tumors are numerous, they may be removed a few at a time, while the large pedunculated form can be readily excised; in any case the excision should be thorough or a regrowth is probable. If the growths are superficial electrolysis or solidified carbon dioxid may be used. A few remedies such as Calcarea fluor., Graphites, and Lycopodium may assist in the treatment.
After the use of injections of paraffin to overcome deformities or to remove lines and wrinkles and otherwise change the contour of the face to suit the whim or fancy of a patient, tumors varying in size from a pea to an egg or larger have developed. The proportion of these occurrences is extremely rare in comparison with the large number of cases treated. These growths are firm in consistency, attached above to the epidermis and embedded below in the subcutaneous tissue. They may appear as bluish or brownish-red hypertrophied lines, may even be keloidal, but usually present no subjective sensations. They occur in from five to fifteen months after the paraffin has been injected and are usually noted about the chin, the angles of the mouth, about the nose, beneath the eyes and in the neck. It is the deformity produced by these tumors which brings them to the dermatologist.
The treatment for this connective-tissue new-growth is complete surgical excision followed by the X-rays. Recurrence may be expected if the paraffin is not removed.