Palmar Fibromatosis: Understanding Your Pathology Report

Section Editor: Bibianna Purgina MD FRCPC
September 21, 2026

Palmar fibromatosis is a noncancerous growth of fibrous tissue in the palm. It is also called Dupuytren disease or Dupuytren contracture. It is the most common type of superficial fibromatosis, a group of growths that develop just under the skin.

Palmar fibromatosis is not a cancer. It does not spread to other parts of the body or turn into cancer. It causes problems by thickening the tissue in the palm, which can pull the fingers toward the palm over time.

The same condition can develop in the sole, where it is called plantar fibromatosis, and in the penis, where it is called penile fibromatosis. Some people develop more than one.

This article explains how doctors diagnose palmar fibromatosis and what the findings in your pathology report mean.

What causes palmar fibromatosis?

The exact cause of palmar fibromatosis is not known. The condition develops when fibroblasts and myofibroblasts, the cells that build and repair connective tissue, multiply in the layer of tissue under the skin of the palm. These cells produce extra collagen, which makes the tissue thick and stiff.

Several factors are linked to a higher chance of developing it:

Family history and ancestry. The condition often runs in families and is most common in people of Northern European ancestry. Studies in England and Denmark estimate it affects about 3.5% to 11% of people.
Age and sex. It becomes more common with age and affects men more often than women.
Diabetes and epilepsy. Both conditions are linked to a higher chance of developing palmar fibromatosis.
Smoking and alcohol. Heavy smoking and heavy alcohol use have both been linked to it.

Repeated heavy use of the hands has been suggested as a cause, but studies disagree. Palmar fibromatosis is not contagious and is not related to cancer in the family.

What are the symptoms of palmar fibromatosis?

Palmar fibromatosis usually develops slowly over years. Many people have it for a long time before it causes any difficulty.

Nodule. The first sign is usually a firm lump in the palm, often near the base of the ring or little finger. The lump may be tender at first and then becomes painless.
Cord. Over time, a thickened band of tissue can form under the skin and extend from the palm into a finger. The skin over it may look puckered or dimpled.
Contracture. As the cord tightens, it pulls one or more fingers toward the palm. The finger can bend but not fully straighten.

A common way to check progress is to try to lay the hand flat on a table. Difficulty doing this is often when people are referred for treatment. Many people have both hands affected, although usually not to the same degree.

How is the diagnosis made?

A doctor usually diagnoses palmar fibromatosis during a physical examination of the hand. Imaging and biopsy are not normally needed.

A pathology report is produced when tissue is removed to improve movement, usually in a procedure called an excision. The tissue removed is the thickened cord or nodule, and it is sent to a pathologist to confirm the diagnosis.

What does palmar fibromatosis look like under the microscope?

Under the microscope, palmar fibromatosis is made of long, thin spindle cells set in dense pink collagen. These cells are fibroblasts and myofibroblasts, the same cells found in normal connective tissue. In palmar fibromatosis, they form small rounded groups called nodules.

The number of cells changes as the condition ages. Early lesions contain many cells and are described as cellular. Older lesions contain fewer cells and more collagen, and are described as hypocellular. Both appearances are normal for this condition.

The tumor cells do not look abnormal under the microscope, and very few of them are dividing. These features help the pathologist distinguish palmar fibromatosis from other spindle-cell growths, such as nodular fasciitis. Additional tests such as immunohistochemistry are usually not needed.

Margins

A margin is the edge of tissue cut by the surgeon. Your report may say that the tissue extends to a margin. For palmar fibromatosis, this is expected.

Surgery for this condition restores finger movement, not removing every abnormal cell. The surgeon removes the cord or nodule limiting movement, and usually leaves some affected tissue behind. A positive margin here does not mean the operation was incomplete, although it is one reason the condition can return in the same hand.

What is the prognosis?

Palmar fibromatosis is not life-threatening. It does not spread, and it does not become cancer. The main concerns are that it can progress over years and that it can come back after treatment.

How often it comes back depends partly on the treatment used. In a five-year comparison of treatments, recurrence was most common after a needle procedure. It was less common after a collagenase injection, and least common after surgical removal of the thickened tissue. Reported rates vary widely between studies.

Some people are more likely to have the condition return. Return is more common in people who develop it at a younger age or who have it in both hands. It is also more common in people with a strong family history or with plantar or penile fibromatosis.

What happens after the diagnosis?

Treatment depends on how much the condition limits hand use. A firm lump with normal finger movement often needs no treatment.

Observation. Many people are monitored because the condition often progresses slowly or stops on its own.
Collagenase injection. A doctor injects an enzyme into the cord to break down the collagen, then straightens the finger. Recovery is quick, and bruising and swelling are common afterward.
Needle procedure. A fine needle divides the cord through the skin. This is the least invasive option and recovery is fast, but the condition returns more often than after surgery.
Surgery. The thickened tissue is removed through an incision in the palm. This usually provides the most lasting improvement, but recovery takes longer and often requires hand therapy. Possible complications include injury to the finger’s small nerves and blood vessels, slow wound healing, and stiffness.

A hand surgeon usually provides treatment. Your surgeon can explain which options suit your disease pattern and what recovery involves. Treatment can be repeated if the condition returns.

Questions to ask your doctor

Which fingers and joints are affected?
Do I need treatment now, or can this be watched?
Which treatment options suit my hand?
How much finger movement can I expect to get back?
How likely is the condition to come back after that treatment?
What does recovery involve, and will I need hand therapy?
What are the possible complications of the procedure you recommend?
Does the report say the tissue extended to a margin, and does that matter here?
Should my other hand be checked?
Would any change in my other health conditions help?