Foreign Body (Solder) and Reaction to the Foreign Body Presenting As a Cutaneous Tender Tumor: Case Report and a New Acronym to Aid in Recalling the Differential Diagnosis of Painful Skin Lesions.

Philip R Cohen,Antoanella Calame,Hadas Skupsky,Christof Erickson

doi:10.7759/cureus.6955

Abstract

Cutaneous tender tumors manifest as painful dermal or subcutaneous masses. Acronyms, a memory aid created from the initial letters of other words, can be used to assist in recalling a list of conditions. We report the case of a man who presented with a painful lesion on his leg; 15 years earlier, hot solder had embedded beneath his skin at that location. The subcutaneous mass was removed, and his symptoms resolved. Microscopic evaluation of the specimen showed a foreign body reaction to metal. Therefore, after correlating his medical history, clinical presentation, and pathology findings, the diagnosis of a foreign body (solder) and a foreign body reaction to solder, as a cause of the patient’s painful skin lesion, was established. Including our patient’s diagnosis for his painful skin lesion, the list of conditions that have been described as presenting as a cutaneous tender tumor include calcinosis cutis, angioendotheliomatosis, leiomyoma, metastases, hidradenoma, osteoma cutis, glomus tumor, scar, fibromyxoma, leiomyosarcoma, eccrine angiomatous hamartoma, Dercum’s disease, piezogenic pedal papule, eccrine spiradenoma, neurilemmoma, something else (such as foreign body (solder) and a reaction to the foreign body), angiolipoma, neuroma, dermatofibroma, granular cell tumor, endometriosis, thrombus, blue rubber bleb nevus, angioma, chondrodermatitis nodularis helicis, and keloid. We introduce a novel acronym for painful lesions of the skin that was inspired by the book Charlotte’s Web in which a barn spider (Charlotte), by weaving praises of a pig (Wilbur) into her web, is responsible for the pig’s life being spared. Wilbur is a calm pig; however, there was an episode when he temporarily fled his pen and was subsequently induced, with a pail of slop, to get back into the pen. The new acronym for cutaneous tender tumors uses the initial letter of each of the 26 currently established painful skin lesions: CALM HOGS FLED PENS AND GET BACK.

Highlights

Dermal and subcutaneous lesions can present as tender masses
Including our patient’s diagnosis for his painful skin lesion, the list of conditions that have been described as presenting as a cutaneous tender tumor include calcinosis cutis, angioendotheliomatosis, leiomyoma, metastases, hidradenoma, osteoma cutis, glomus tumor, scar, fibromyxoma, leiomyosarcoma, eccrine angiomatous hamartoma, Dercum’s disease, piezogenic pedal papule, eccrine spiradenoma, neurilemmoma, something else (such as foreign body and a reaction to the foreign body), angiolipoma, neuroma, dermatofibroma, granular cell tumor, endometriosis, thrombus, blue rubber bleb nevus, angioma, chondrodermatitis nodularis helicis, and keloid
In 1993, Naversen et al introduced a new acronym for the painful tumors of the skin, which included leiomyoma, eccrine spiradenoma, neuroma, dermatofibroma, angiolipoma, neurilemmoma, endometrioma, glomus tumor, and granular cell tumor: LEND AN EGG [2]

Summary

Introduction

Dermal and subcutaneous lesions can present as tender masses. the diagnosis may be suspected based on the clinical history or the location or the morphology of the tumor, a biopsy for pathologic evaluation is often required to establish the diagnosis. A 74-year-old man presented for the evaluation and treatment of a painful lesion on his right leg of several years’ duration His medical history is significant for prostate cancer (treated with radiotherapy and leuprolide acetate injections every three months) and hand dermatitis (with patch test confirmed allergic contact dermatitis to four allergens: diazolidinyl urea, methylchloroisothiazinoline/methylisothiazinolone, tixocortol-21-pivalate, and wool alcohol). Distant (a) and closer (b) views of the posterior medial right thigh of a 74-year-old man showed a dark brown 5 x 5 millimeter patch surrounded by a lighter tan brown patch (black arrow) It is located at the same site on which hot solder dripped onto his right leg and embedded beneath the skin 15 years earlier. The patient has had no further episodes of pain at that location

Discussion

C Chondrodermatitis nodularis helicis

Conclusions

Disclosures