Amorphous Basophilic Deposit in the Superficial Dermis of the Lip in an 80 Year Old

Abstract

An 80-year-old woman presented with a 3 mm pearly, translucent papule in her left upper cutaneous lip of 2 months duration which was biopsied to rule out basal cell carcinoma. Histopathologic examination revealed acellular, basophilic material in the superficial dermis, extending to the base of the biopsy. There was neither an epithelial component nor an inflammatory reaction associated with it. The amorphous, nonpolarizable material stained with Alcian Blue (pH 2.5) and with colloidal iron, but was negative with a Periodic acid-Schiff stain, indicative of an acidic mucin, such as weakly sulfated mucin of salivary gland origin or a dermal-origin mucin. The material was digested with hyaluronidase, consistent with the mesenchymal-origin mucin hyaluronic acid (HA). Additional clinical history was obtained; the patient had previous HA (Restylane) injections at another institution. We report a case of superficially applied HA and consider the histopathologic differential diagnosis of endogenous and injected mucin in the dermis.

Lip Nodules Caused by Hyaluronic Acid Filler Injection: Report of Three Cases

“…The basophilic nature of HA may be mistaken for the myxoid fibroplasias often seen around tumor islands in basal cell carcinomas [16,17].…”

Migrating Granulomatous Chronic Reaction from Hyaluronic Acid Skin Filler (Restylane): Review and Histopathological Study with Histochemical Stainings

“…Although it contains trace amounts of bacterial proteins and is generally well tolerated, there have been rare reports of occasional allergic hypersensitivity reactions [3,4,5] and of long-term cutaneous adverse reactions displaying two different histological patterns, i.e. granulomatous and non-granulomatous [1,6,7,8]. These reactions may be due to the reformulation of Restylane in 1999 into a more purified HA raw material containing less bacterial protein.…”