Abstract
A 13-year-old female patient with a history of Hirschsprungs disease presented to dermatology clinic with a linear array of firm, erythematous to yellow verrucous papules on the right frontal scalp extending to the vertex that had been present for two years. The patient continued to develop new papules, and once a papule emerged, it did not fade away, but became additive to the overall amalgamated lesion. No previous scalp lesions or trauma to the region were reported. Shave biopsy revealed extensive ectopic benign-appearing woven bone filling the dermis and extending into the subcutis, consistent with osteoma cutis. The clinical appearance of the lesion, combined with the histologic features, was most compatible with plate-like osteoma cutis, a rare disorder of cutaneous ossification. Osteoma cutis is often idiopathic in nature, but may also be associated with dysregulation of calcium and phosphate metabolism. It can be associated with congenital disorders such as Albright hereditary osteodystrophy, progressive osseous heteroplasia, or fibrodysplasia ossificans progressiva. Plate-like osteoma cutis is most often congenital, but may be acquired in rare cases, such as this one. Further laboratory workup for our patient revealed normal calcium, phosphate, and parathyroid hormone levels. X-rays of the skull showed calcifications of the right scalp with no thickening or underlying skull involvement. This case represents a unique childhood presentation of acquired plate-like osteoma cutis.
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