Indian Journal of Dermatology
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CORRESPONDENCE
Year : 2021  |  Volume : 66  |  Issue : 2  |  Page : 205-206
A rare case of nail bed foreign body granuloma with malignant dermoscopic appearance


1 Department of Dermatology, The Second Affiliated Hospital of Guangzhou Medical University, China
2 Pathology, The Second Affiliated Hospital of Guangzhou Medical University, China

Date of Web Publication16-Apr-2021

Correspondence Address:
Wenlin Yang
Department of Dermatology, The Second Affiliated Hospital of Guangzhou Medical University
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_630_19

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How to cite this article:
Xiong J, Yin J, Ren Y, Xu M, Chen Y, Ouyang X, Yang W. A rare case of nail bed foreign body granuloma with malignant dermoscopic appearance. Indian J Dermatol 2021;66:205-6

How to cite this URL:
Xiong J, Yin J, Ren Y, Xu M, Chen Y, Ouyang X, Yang W. A rare case of nail bed foreign body granuloma with malignant dermoscopic appearance. Indian J Dermatol [serial online] 2021 [cited 2021 Oct 21];66:205-6. Available from: https://www.e-ijd.org/text.asp?2021/66/2/205/313765




Sir,

Foreign body granuloma is a benign lesion caused by a chronic inflammatory response to exogenous or ectopic endogenous materials, such as cosmetic filling, retained surgical materials, injection of drugs or vaccines, and so on.[1] Recently, it was proposed that dermoscopic appearance could be a clue for the diagnosis of dermal granuloma.[2] To the best of our knowledge, only one case of foreign body granuloma was reported with dermoscopic description, which suggested blue nevus though.[3] Here, we report an unusual foreign body granuloma case, in which malignant dermoscopic appearance was observed.

A 74-year-old woman was presented with an ulcer and a mass on her first right toe. The patient denied any injury history and family history. Examination showed the distal portion of the first right toe was diffusely swollen. There was a dome-shaped light reddish mass (diameter: 0.8 cm) on the nail plate with blood crusts, bloody and purulent secretion on the top [Figure 1]a. The patient felt pain on touch.
Figure 1: (a) A 74-year-old woman developed a dome-shaped light reddish mass (diameter: 0.8 cm) with blood crust on the top and bloody and purulent secretion on the nail plate of the first right toe. (b) The bamboo stick found in the lesion during the surgery. (c) No recurrence observed 7 months after the surgery

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Dermoscopic examination was carried out as a non-invasive method widely applied on the diagnosis and differentiation in dermatology in recent years. The dermoscopy on our patient showed yellowish-red background, blue-gray ovoid nests in the upper, blood crusts and a bright reddish mass in the middle surrounded by some orange areas [Figure 2]. Notably, the blue-gray ovoid nest is a typical feature of basal cell carcinoma (BCC) on dermoscopy.[4] Therefore, a biopsy was strongly recommended for a further confirmed diagnosis.
Figure 2: Polarized dermoscopic view showed yellowish-red background, blue-gray ovoid nests (arrows) in the upper, blood crust and bright reddish mass in the middle surrounded by some orange areas

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As the planned incision along the margin of the mass was performed, the reddish mass was removed with caution. Unexpectedly, a 2-cm long rough bamboo stick was discovered under the mass, partially penetrating the nail bed [Figure 1]b. The stick was entirely taken out with tweezers, followed by debridement and suturing. Histopathology of the mass showed infiltration of lymphocytes, neutrophils and histocytes, endothelial and capillary hyperplasia in the dermis. The wound healed well 2 weeks after the surgery and no recurrence occurred in the 7-month follow-up [Figure 1]c.

The foreign bamboo stick discovered during the biopsy, histopathology, and quick recovery after the surgery is consistent with the diagnosis of foreign body granuloma, which is also supported by the observed swelling and purulent secretion as a foreign body granuloma is usually accompanied with local superficial infection.[1] Consistently, the yellowish-orange area that is supposed to be a clue to granulomatous diseases in the limited literature[2] was observed in the dermoscopic view. Interestingly, we even observed some malignant appearance like blue-gray ovoid nests on dermoscopy, indicating that foreign body granuloma can also mimic the malignant lesions on dermoscopy, which calls for attention in the clinical practice.

In conclusion, we report a nail bed foreign body granuloma, which lacks the injury history and mimics the malignant lesions in both dermoscopic and clinical manifestations but was finally confirmed by surgery and pathological examination.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgements

We acknowledge the support and help from Dr. Ouyang and the Department of pathology in the Second Affiliated Hospital of Guangzhou Medical University.

Financial support and sponsorship

The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Molina-Ruiz AM, Requena L. Foreign body granulomas. Dermatol Clin 2015;33:497-523.  Back to cited text no. 1
    
2.
Bombonato C, Argenziano G, Lallas A, Moscarella E, Ragazzi M, Longo C. Orange color: A dermoscopic clue for the diagnosis of granulomatous skin diseases. J Am Acad Dermatol 2015;72 (1 Suppl):S60-3.  Back to cited text no. 2
    
3.
Yoshikawa M, Kamiya T, Sumikawa Y, Uhara H. Unique dermoscopic feature of a long-standing pencil core granuloma on the head. J Dermatol 2019;46:e172-3.  Back to cited text no. 3
    
4.
Lallas A, Apalla Z, Argenziano G, Longo C, Moscarella E, Specchio F, et al. The dermatoscopic universe of basal cell carcinoma. Dermatol Pract Concept 2014;4:11-24.  Back to cited text no. 4
    


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