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Osteoma Cutis

  • Author: Luke Lennox, MD; Chief Editor: William D James, MD  more...
 
Updated: Mar 20, 2015
 

Background

Strictly defined, osteoma cutis refers to the presence of bone within the skin in the absence of a preexisting or associated lesion. This is opposed to secondary types of cutaneous ossification that can occur in reaction to inflammatory, traumatic, and neoplastic processes.[1, 2]

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Pathophysiology

Bone arises in skin and soft tissues through mesenchymal (membranous) ossification without cartilage precursors or models (as in endochondral ossification of the skeletal system).

The lesions of osteoma cutis differ from calcinosis cutis in that they represent bone formation (dermal deposition of hydroxyapatite crystals) versus calcium salt deposits.

The pathogenesis of primary osteoma cutis has the following two proposed mechanisms[3] :

  • Through mesenchymal cells differentiating into osteoblasts and then migrating to an abnormal location
  • Through an osteoblastic metaplasia of mesenchymal cells already in the dermis, such as fibroblasts
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Epidemiology

Frequency

United States

Although considered rare, with no well-defined data on incidence, a plethora of conditions and syndromes may be found in association with osteoma cutis. Hence, the frequency of its occurrence varies accordingly. Primary lesions with no underlying cause are even rarer, but they account for approximately 20% of all skin ossifications. Reported in 1977, of 20,000 consecutive skin biopsies, only 35 cutaneous osteomas were found. Ten of them were primary, while 25 appeared secondary to another abnormality (although long ago, this allows some insight into its rarity).[1, 2]

Mortality/Morbidity

Osteoma cutis is not life threatening, although local discomfort and/or disfigurement may lead the patient to seek consultation.

Race

No particular race is predisposed to developing osteoma cutis.

Sex

Generally, no distinct sexual predominance exists. However, one cause of osteoma cutis, Albright hereditary osteodystrophy, occurs with a female-to-male ratio of 2:1.

Age

Osteoma cutis may occur at any age. Of note, multiple miliary osteoma cutis classically presents in middle-aged white women.[4]

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Contributor Information and Disclosures
Author

Luke Lennox, MD Resident Physician, Department of Medicine, University of Buffalo, State University of New York School of Medicine and Biomedical Sciences

Disclosure: Nothing to disclose.

Coauthor(s)

Thomas N Helm, MD Clinical Professor of Dermatology and Pathology, University of Buffalo, State University of New York School of Medicine and Biomedical Sciences; Director, Buffalo Medical Group Dermatopathology Laboratory

Thomas N Helm, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society of Dermatopathology

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD Herman Beerman Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society of Dermatopathology, Pennsylvania Academy of Dermatology

Disclosure: Received royalty from Lippincott Williams Wilkins for textbook editor.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

James W Patterson, MD Professor of Pathology and Dermatology, Director of Dermatopathology, University of Virginia Medical Center

James W Patterson, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Society of Dermatopathology, Royal Society of Medicine, Society for Investigative Dermatology, United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Acknowledgements

Kevaghn P Fair, DO Consultant Pathologist and Founder, Dominion Pathology Laboratories

Kevaghn P Fair, DO is a member of the following medical societies: American Society for Clinical Pathology, American Society of Dermatopathology, and College of American Pathologists

Disclosure: Nothing to disclose.

References
  1. Burgdorf W, Nasemann T. Cutaneous osteomas: a clinical and histopathologic review. Arch Dermatol Res. 1977 Dec 12. 260(2):121-35. [Medline].

  2. Roth SI, Stowell RE, Helwigeb. Cutaneous ossification. Report of 120 cases and review of the literature. Arch Pathol. 1963 Jul. 76:44-54. [Medline].

  3. Talsania N, Jolliffe V, O'Toole EA, Cerio R. Platelike osteoma cutis. J Am Acad Dermatol. 2011 Mar. 64(3):613-5. [Medline].

  4. Chabra IS, Obagi S. Evaluation and management of multiple miliary osteoma cutis: case series of 11 patients and literature review. Dermatol Surg. 2014 Jan. 40(1):66-8. [Medline].

  5. Cohen PR, Tschen JA, Schulze KE, Martinelli PT, Nelson BR. Dermal plaques of the face and scalp. Platelike osteoma cutis. Arch Dermatol. 2007 Jan. 143(1):109-14. [Medline].

  6. Coutinho I, Teixeira V, Cardoso JC, Reis JP. Plate-like osteoma cutis: nothing but skin and bone?. BMJ Case Rep. 2014 May 5. 2014:[Medline].

  7. Ward S, Sugo E, Verge CF, Wargon O. Three cases of osteoma cutis occurring in infancy. A brief overview of osteoma cutis and its association with pseudo-pseudohypoparathyroidism. Australas J Dermatol. 2011 May. 52(2):127-31. [Medline].

  8. Worret WI, Burgdorf W. [Congenital, plaque-like osteoma of the skin in an infant]. Hautarzt. 1978 Nov. 29(11):590-6. [Medline].

  9. Riahi RR, Cohen PR. Multiple miliary osteoma cutis of the face after initiation of alendronate therapy for osteoporosis. Skinmed. 2011 Jul-Aug. 9(4):258-9. [Medline].

  10. Altman JF, Nehal KS, Busam KJ, Halpern AC. Treatment of primary miliary osteoma cutis with incision, curettage, and primary closure. J Am Acad Dermatol. 2001 Jan. 44(1):96-9. [Medline].

  11. Kim SY, Park SB, Lee Y, Seo YJ, Lee JH, Im M. Multiple miliary osteoma cutis: treatment with CO(2) laser and hook. J Cosmet Laser Ther. 2011 Oct. 13(5):227-30. [Medline].

  12. Cohen AD, Chetov T, Cagnano E, Naimer S, Vardy DA. Treatment of multiple miliary osteoma cutis of the face with local application of tretinoin (all-trans-retinoic acid): a case report and review of the literature. J Dermatolog Treat. 2001 Sep. 12(3):171-3. [Medline].

  13. Baskan EB, Turan H, Tunali S, Toker SC, Adim SB, Bolca N. Miliary osteoma cutis of the face: treatment with the needle microincision-extirpation method. J Dermatolog Treat. 2007. 18(4):252-4. [Medline].

  14. Ragsdale BD. Lever's Histopathology of the Skin. Philadelphia, Pa: Lippincott-Raven; 1997. 965-7.

  15. Watsky KL. Arndt KA, ed. Cutaneous Medicine and Surgery. Philadelphia, Pa: WB Saunders; 1996. 1828-31.

  16. Weedon D, ed. Skin Pathology. 2nd ed. New York, NY: Churchill Livingstone; 2002. 355-7.

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A microscopic view of osteoma cutis shows well-formed mature trabecular bone just beneath the epidermis. Note the absence of hematopoietic elements in the medullary spaces.
Solitary nodule on the frontal part of the scalp.
Miliary cutaneous osteomata. Multiple, small, bluish, stony-hard nodules in an acneiform distribution along the cheeks.
Osteoma cutis is often identified as an incidental finding on examination of re-excision specimens. This excisional specimen failed to reveal residual basal cell carcinoma, but an osteoma cutis was evident. Further examination reveals prominent calcification with only a very narrow rim of osteoid in the periphery.
High-power examination reveals adipocytes centrally and a prominent calcified matrix surrounded by osteoid.
 
 
 
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