That’s Not Molluscum! A literature review of 109 cases of subepidermal calcified nodules

Abstract

Calcinosis cutis is an abnormal deposition of calcium in the skin or subcutaneous tissue and can be categorized into five subgroups: dystrophic, metastatic, iatrogenic, calciphylaxis, and idiopathic. 1,2 Subepidermal calcified nodules (SCN) are an uncommon form of idiopathic calcinosis cutis that typically presents on children's faces as whitish, yellow papules. 3,4 (Figure 1). They are often mistaken for verrucae or molluscum. 3,5 However, subepidermal calcified nodules are a distinct benign entity and can be treated by excision. 6,7 We present a literature review of current SCN case reports. | ME THODSA literature review was conducted on PubMed using the terminology "subepidermal calcified nodule" and "idiopathic calcinosis cutis." The search occurred on March 19, 2020, was not limited by date, and resulted in 268 journal articles. A total of 227 articles were excluded from data analysis due to the topic being unrelated to subepidermal calcified nodules (n = 219), unavailability of full text (n = 4), unavailability of article in English (n = 3), or lack of patient data (n = 2). The remaining 39 case reports and series were analyzed. The following data were extracted: age of patients, sex of patients, presence of systemic disease, location of lesion(s), maximum size of lesion(s), number of lesion(s), duration of lesion(s), symptoms, differential diagnoses, histopathological findings, and treatment(s) (Table 1). | RE SULTS | DemographicsA total of 109 patients (male = 70, female = 39) with median (IQR) age of 12 (10.8) were reported with subepidermal calcified nodules, which were confirmed by biopsy. Of these, 73 patients were pediatric (Pd), age < 18, and 16 patients were adults (Ad), age ≥ 18, and 20 patients' ages were not noted (NN). Median (IQR) age was 10.5 (9.0) and 40 (53.5) for the pediatric and adult populations, respectively. Most patients (96%; Pd = 71, Ad = 15, NN = 20) did not have any systemic diseases (Table 1).

A Firm, Verrucous, Hyperkeratotic Periorbital Papule on an Adult Man: Answer

“…Other reported treatments include carbon dioxide laser, topical salicylic acid, liquid nitrogen, or conservative management with no intervention. 2…”

“…3 SCN is rare in adults, with the largest literature review of 109 patients showing that only 16 cases were in adult patients. 2 SCN typically presents as a single, verrucous or smooth, yellowish-white papule ,1 cm on the face, with the most common location being the eyelid (40% of cases). 1,2 Other less common locations include the scalp and extremities.…”

“…2 SCN typically presents as a single, verrucous or smooth, yellowish-white papule ,1 cm on the face, with the most common location being the eyelid (40% of cases). 1,2 Other less common locations include the scalp and extremities. Most SCN lesions are solitary, but multiple lesions have been reported, including bilateral symmetric periorbital lesions.…”

“…Most SCN lesions are solitary, but multiple lesions have been reported, including bilateral symmetric periorbital lesions. 2,4 Most SCN (95%) are asymptomatic; however, rarely have been reported to be associated with pain/discomfort, pruritus, or swelling. 2 The lesions were typically present for 6-12 months before patients seeking care.…”

Diagnostic aid to subepidermal calcified nodule with dermoscopy and reflectance confocal microscopy: a case report

“…Seventy-two percent of patients are younger than 18 years old. The lesions present asymptomatic, painless, hard, and freely mobile nodules and can be single (82%) or multiple (18%) [4]. In a few cases, the papule may hemorrhage [5].…”