Foreign body cutaneous granuloma associated with a rose thorn: dermoscopy will tell you more

A 64-year-old woman presented with a reddish nodule with a black center which occurred around 2 months before, after gardening (figs. 1 A). Dermoscopy showed a linear, cone-shape dark structure surrounded with red structureless areas, polymorphic vessels and small erosions (figs. 1 B, C). A meticulous enquiry on her gardening work along with dermoscopic assessment, made a thorn of the rose associated cutaneous foreign body granuloma the most possible diagnosis. After administering local anesthesia, the plant thorn was removed, leading to clinical improvement (figs. 1 D–F).
Foreign body cutaneous granuloma (FBCG) is a chronic inflammatory process, which may be induced by different factors, including but not limited to ingrowing hairs, surgical sutures, pencil cores, tattoo pigments, glass, cosmetic fillers or plant thorns [1, 2]. It usually presents as an asymptomatic or painful/itchy pink-reddish nodule, papule or plaque, which becomes fibrotic over time. Clinical diagnosis may sometimes be challenging, especially when the patient does not remember the disease onset or possible inducing events.
Dermoscopy is an auxiliary tool to diagnose FBCG and – as presented – may be particularly useful in visualization of the foreign body within the lesion. Dermoscopic findings of FBCG seem to be variable – pinkish/reddish structureless areas, linear vessels, scales, and scar-like white areas have been described. Interestingly, in most of the described cases, causative factors could not be directly visualized [1, 2]. As mentioned, FBCG commonly presents as an amelanotic nodule and thus may mimic other benign and malignant lesions [1]. In a case of a pencil core FBCG other blue lesions should also be considered among differential diagnoses [2]. In the presented case, the patient’s history and the thorn of the rose visible on dermoscopic assessment was sufficient to make a decision about patient management. However, in any uncertainty, biopsy and histopathological assessment should be performed.

CONFLICT OF INTEREST

The authors declare no conflict of interest.

Kobieta w wieku 64 lat zgłosiła się do Kliniki Dermatologii z powodu czerwonawego guzka z centralnym skupieniem barwnika. Zmiana pojawiła się 2 miesiące wcześniej, po wykonywaniu prac w ogrodzie (ryc. 1 A). W badaniu dermoskopowym uwidoczniono wydłużoną, stożkowatego kształtu strukturę barwnikową, otoczoną czerwonym obszarem bezstrukturalnym z widocznymi naczyniami...


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