Calcinosis Cutis Workup

Updated: Mar 05, 2020
  • Author: Julia R Nunley, MD; Chief Editor: Dirk M Elston, MD  more...
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Workup

Laboratory Studies

Tests of serum calcium, inorganic phosphate, alkaline phosphatase, and albumin levels may be helpful. An elevation in serum calcium and alkaline phosphatase levels with a decrease in the inorganic phosphate level is suggestive of hyperparathyroidism. One can further calculate the calcium-phosphate product to determine if the threshold of 70 mg2/dL2 is exceeded. An albumin value is needed to interpret the significance of hypocalcemia or hypercalcemia. Calcium is highly protein bound, and abnormalities in the albumin concentration may cause clinically insignificant abnormalities of calcium concentration.

Additionally, note the following:

  • Serum blood urea nitrogen and creatinine concentrations can be obtained to measure renal function.

  • On the complete blood cell count with differential, hematologic abnormalities may suggest an underlying malignancy or lupus erythematosus.

  • If milk-alkali is suspected, the plasma bicarbonate or arterial pH value may indicate the presence of a metabolic alkalosis.

  • The parathyroid hormone concentration is a direct measurement for hyperparathyroidism.

  • Creatine kinase and aldolase value may be significantly abnormal in cases of dermatomyositis, myositis, or rhabdomyolysis.

  • Serum amylase or lipase levels are markers of pancreatic disease.

  • Antinuclear antibody testing is helpful in screening for lupus erythematosus.

  • In patients with scleroderma, the presence of SCL-70 (topoisomerase) antibody portends a poor prognosis.

  • Vitamin D levels should be determined to evaluate the possibility of vitamin D excess or deficiency. [20]

  • A test of the 24–hour urinary excretion of calcium and/or inorganic phosphate may be useful.

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Imaging Studies

Radiographic examination may demonstrate the extent of tissue calcification.

Bone scintigraphy with radiolabeled phosphate compounds (technetium Tc 99m methylene diphosphonate [MDP]) is useful in evaluating nonvisceral soft tissue calcification; this test is more sensitive than plain radiography. [21, 22]

CT allows for the identification of visceral and nonvisceral calcification. CT is infrequently used in evaluating calcinosis cutis and primarily used in assessing tumoral calcinosis.

MRI is of limited utility in evaluating calcified structures, but calcific deposits have characteristic patterns. The granulomatous foreign body reaction in tumoral calcinosis is evident.

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Procedures

Findings on biopsy and histopathologic examination of a cutaneous lesion are diagnostic.

Results of fine-needle aspiration cytology of a skin nodule may also be diagnostic.

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Histologic Findings

On biopsy, granules and deposits of calcium are seen in the dermis, with or without a surrounding foreign-body giant cell reaction. Alternatively, massive calcium deposits may be located in the subcutaneous tissue. In areas of necrosis, calcium deposition is frequently found within the walls of small and medium-sized blood vessels. Calcium deposition may be confirmed on Von Kossa and alizarin red stains.

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