Dear Editor:

Soft fibroma (acrochordon, fibroepithelial polyp, or skin tag) is a common pedunculated skin neoplasm and usually appears as a furrowed papule, filiform lesion, or large bag-like protrusion. Soft fibromas primarily occur on the neck, axillae, and groin. However, it may present at unusual sites of the body such as the penis, urethra, and vulva. Moreover, a few reports on soft fibromas occurring on the breast and nipple have been published[@B1]. Herein, we report a rare and interesting case of a soft fibroma arising from the nipple, showing an unusual cauliflower-like appearance.

A 51-year-old obese woman presented with a 25-year history of a painless pedunculated polyp originating from her right nipple. The lesion measured 2.4×2.3×1.4 cm and demonstrated a verrucous and cauliflower-like surface ([Fig. 1A, B](#F1){ref-type="fig"}). Neither acanthosis nigricans nor epidermal nevus was observed on the adjacent skin. Dermoscopy revealed irregular epidermal projections and focal dotted vessels ([Fig. 1C](#F1){ref-type="fig"}). Total surgical excision of the polyp, sparing the right nipple, was performed. Histopathological analysis showed papillomatosis, hyperkeratosis, and regular acanthosis of the epidermis with fibrocollagenous tissue in the dermis ([Fig. 1D](#F1){ref-type="fig"}). On the basis of these findings, we diagnosed the lesion as a soft fibroma.

There have been only a few reports on soft fibromas of the nipple presenting with bullous formation or comprising a large elastic mass with a short pedicle[@B2],[@B3]. Furthermore, there has been no report of a large and cauliflower-like soft fibroma of the nipple in the Korean literature. Because the clinical manifestations of soft fibroma of the nipple are nonspecific, histological examination is required for differential diagnosis, including pedunculated seborrheic keratosis, pleomorphic fibroma, nevoid hyperkeratosis of nipple and areola, and verruca vulgaris.

In our case, the unusual clinical presentation of the cauliflower-like nipple tumor made the diagnosis of the lesion difficult. However, the histopathological findings provided important clues for making an accurate diagnosis. Thus, we have described a rare and interesting case of a cauliflower-like soft fibroma of the nipple.

![(A) A large solitary pedunculated polyp originating from the right nipple. (B) The polypoid lesion measuring 2.4×2.3×1.4 cm and demonstrating a cauliflower-like surface. (C) Dermoscopic findings showing irregular epidermal projections and focal dotted vessels. (D) Polypoidal lesion showing mild acanthosis and prolongations of the rete ridges with fibrocollagenous stroma (H&E, ×12.5).](ad-27-102-g001){#F1}
