A Case of Graphite Foreign Body Misdiagnosed as Blue Nevus

Abstract

The lead of a pencil is composed of graphite and clay. Although considered as biologically inert for a long time, the lead of a pencil can result in undesirable local pain, pigmentation, abscess formation and graphite foreign body reaction. Therefore, all penetrating injuries caused by a pencil should be carefully assessed and treated in order to remove all pieces of lead from the wound by specialized paramedics or medical doctors. We should be aware that graphite granules embedded in the skin may give rise to clinically alarming delayed reactions. Here we present a 19-year-old woman with a foreign body, the lead of a pencil, misdiagnosed as a blue nevus.

Intraoral pencil core granuloma with retained pencil lead

“…Though graphite and clay are biologically inert, if left in the tissue for a long time, these can result in undesirable local pain, pigmentation, abscess formation, and foreign body reaction. [ 2 ] Several reports from the literature indicate that stab injuries by pencil can cause such soft tissue reactions. The sites most affected are the limbs because they are areas that are more exposed to mechanical traumas.…”

“…Graphite particles may cause graphite pneumoconiosis, a chronic granulomatous reaction in the lungs. [ 2 ] Rarely, graphite foreign body granuloma, also known as pencil core granuloma, can occur that is characterized by a delayed foreign body reaction against the fragments of pencil lead, which at the macroscopic level resembles malignant melanoma. [ 2 ] The reaction against the pencil lead takes a long time until the graphite particle disintegrates to a critical size in the skin.…”

“…[ 1 ] If these pencil lead wounds are left untreated, they can result in undesirable local pain, pigmentation, graphite foreign body reaction, and granuloma or abscess formation. [ 2 ] The occurrence of pencil core granulomas is very rare and only a few case reports have been documented in the literature. Most of these are reported on limbs as hyperpigmented nodules in the skin, secondary to a retained pencil core.…”

Graphite Foreign Body Misdiagnosed as a Blue Naevus-Like Localised Argyria

“…Although usually insignificant, pencil-tip injuries have the potential to provoke granulomatous reactions, 1,2 which may lead to undesirable consequences, namely pigmentation and abscess formation. 3 While such outcomes are rare, it is important that clinicians are aware of them; a small number of cases have been described in which pencil core granulomas have presented to dermatologists as suspected soft tissue sarcomas, haemangiomas and melanomas. 1 Here, we present a case of graphite foreign body granuloma, originally thought to be a blue naevus-like localised argyria.…”

A Case of Pencil-Core Granuloma after Hyaluronic Acid Filler Injection

“…To our knowledge, there are only three cases of pencil-core granuloma in the Korean literature ( Table 1 ) 4 5 . In two previous cases, the lesion was located on the extremities, and the lag periods were shorter than in our case.…”