Clinical Challenge: Asymptomatic Growth on the Upper Forehead - MPR

Clinical Challenge: Asymptomatic Growth on the Upper Forehead

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A 31-year-old woman presents for evaluation and requests removal of a disfiguring growth on her upper forehead. The lesion has been present for at least 4 years and has gradually increased in size. The lesion is not painful and there is no drainage. The patient’s medical history is unremarkable. She denies antecedent trauma to the site, similar lesions, or family history of skin cancer. Examination reveals a 3cm firm, flesh-colored nodule that is adherent to underlying structures.

Osteomas are well-defined tumors that are induced by the proliferation of bone. Lesions increase in size gradually and are painless. The pathogenesis is uncertain; postulated causes of osteoma include a latent developmental defect or an exaggerated response to a traumatic...

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Osteomas are well-defined tumors that are induced by the proliferation of bone. Lesions increase in size gradually and are painless. The pathogenesis is uncertain; postulated causes of osteoma include a latent developmental defect or an exaggerated response to a traumatic incident.1 The condition occurs more commonly in men than women and may also arise in children, teenagers, and young adults. Osteomas comprise 3% of primary bone tumors.2  Osteomas may be associated with Gardner syndrome.3  

The preferred diagnostic procedure is computerized tomographic imaging revealing a well-demarcated, homogenous, dense mass.4 Histologic examination reveals foci of woven bone with a paucity of osteoblasts and osteoclasts.5 Lesions are resected if they interfere with function or, as with this case, for cosmesis.

Linda Weinberg, CRNP, PhD, is a nurse practitioner at the DermDox Center for Dermatology in Leola, Pennsylvania. Stephen Schleicher, MD, is director of the DermDox Center for Dermatology in Pennsylvania, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College.                  

References

1. Kucukkurt S, Özle M, Baris E. Peripheral osteoma in an unusual location on the mandible. BMJ Case Rep. 2016;2016:bcr2016216554.

2. Khan AN. Osteoid osteoma imaging. Medscape. https://emedicine.medscape.com/article/392850-overview. Updated February 11, 2020. Accessed July 15, 2020.

3.  Panjwani S, Bagewadi A, Keluskar V, Arora S. Gardner’s syndromeJ Clin Imaging Sci. 2011;1:65.

4. Papathanassiou ZG, Megas P, Petsas T, Papachristou DJ, Nilas J, Siablis D. Osteoid osteoma: diagnosis and treatmentOrthopedics. 2008;31(11):1118.

5. Nielsen GP, Rosenberg AE. Update on bone forming tumors of the head and neckHead Neck Pathol. 2007;1(1):87-93.