Image Gallery: Maggot on my shoulder

Abstract

DEAR EDITOR, A 16-year-old previously healthy boy sought consultation for a swelling over his right shoulder of 8 months' duration, which he described as a 'maggot being stuck on'. On examination, an oval compressible swelling with rugose skin surface was noted (a). A firm nodule was palpable at the floor of the swelling. The excision specimen showed a nodular tumour with specks of calcification at the undersurface (b). Histopathology revealed a well-circumcised tumour in the dermis and subcutis showing basophilic and shadow cells and keratin pearls (c). The overlying epidermis showed extensive elastolysis (d). On clinicopathological correlation, anetodermic pilomatricoma was diagnosed. Anetodermic pilomatricoma is a rare variant commonly affecting the shoulder, trunk and proximal arm.1 The suggested mechanisms of its development include trauma, mechanical obstruction to lymphatic drainage and release of elastolytic enzymes by the tumour per se.

Pilomatricoma: Clinical, Dermoscopic Findings and Management in 55 Pediatric Patients and Concise Review of the Literature With Special Emphasis on Dermoscopy

“…Additionally, atypical pilomatricomas with an anetodermic appearance have also been reported [ 5 , 9 , 11 ]. In the literature, ultrasound was used to confirm, support or exclude the diagnosis of pilomatricoma [ 18 , 19 ]. Once the diagnosis has been confirmed, surgical excision may be considered for aesthetic and functional reasons.…”

Anetodermic pilomatricoma: A clinical, histopathological and dermoscopic perspective

“…Pilomatricoma is an uncommon benign cutaneous appendageal tumour, which presents as a single firm, deep‐seated nodule with normal overlying skin 2 . When the overlying skin is stretched, several facets and irregular angles may be observed, which is known as the ‘tent sign.’ 1 Anetodermic changes over pilomatricoma have been reported in the past 3 but are extremely rare. It comprises atrophic, wrinkled, pink, striae‐like skin overlying a typical pilomatricoma 2,3 that frequently herniates above the cutaneous plane to give a bullous appearance, 4 as observed in all the patients in this series.…”

“…When the overlying skin is stretched, several facets and irregular angles may be observed, which is known as the ‘tent sign.’ 1 Anetodermic changes over pilomatricoma have been reported in the past 3 but are extremely rare. It comprises atrophic, wrinkled, pink, striae‐like skin overlying a typical pilomatricoma 2,3 that frequently herniates above the cutaneous plane to give a bullous appearance, 4 as observed in all the patients in this series. However, anetoderma gives a unique opportunity to study the dermoscopic features of this deep‐seated tumour.…”