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Firm digital papulonodules in a young boy

A 3-year-old boy presented with firm, non-tender papulonodules over the left middle finger. They were initially thought to be insect bites then became firm over 2 weeks then gradually increased in size over 6 months. On examination there was a 1.2 9 0.9 cm firm nodule on the radial aspect and another 0.5 9 0.5 cm firm papule on the ulnar aspect of the left middle finger middle phalanx (Fig. 1). Radiographic examination showed soft tissue swelling without bony abnormalities. Biopsy of the lesion showed spindled cells containing round to ovoid cytoplasmic inclusion bodies, consistent with the diagnosis of infantile digital fibromatosis (Fig. 2). The lesions were excised with full-thickness skin grafting. However, 2 months postoperatively, a new fleshy nodule developed on the ulnar aspect of the left index finger over the distal interphalangeal joint (Fig. 3).