Osteoma Cutis

Back

Background

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

Pathophysiology

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

The lesions of osteoma cutis differ from tumoral calcinosis in that they represent bone formation, and calcinosis refers to calcium salt deposits.

In addition to colonic polyposis, epidermal cysts of the face and the scalp, and multiple fibromas, osteomatosis in the form of intraosseous (not cutaneous) osteomas may develop within the membranous bones of the head in Gardner syndrome.

Epidemiology

Frequency

United States

Although said to be rare, with no well-defined data on the incidence, a plethora of conditions and syndromes may be found in association with osteoma cutis, and the frequency of its occurrence varies accordingly. Primary lesions with no underlying cause are even rarer, but they account for approximately 20% of all cases.

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.

History

Physical

Causes

Osteoma cutis is a feature in several groups of patients.

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Small spicules to large masses of mature bone are found in the dermis or extend into the subcutaneous tissue. Spicules of bone may enclose areas of mature fat, recapitulating a medullary cavity, but hematopoietic elements are seldom observed.


View Image

A microscopic view of osteoma cutis shows well-formed mature trabecular bone just beneath the epidermis. Note the absence of hematopoietic elements in....

Medical Care

Consultations

Prognosis

Author

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

Disclosure: Nothing to disclose.

Specialty Editors

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

Disclosure: Nothing to disclose.

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

Disclosure: Nothing to disclose.

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

Disclosure: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting

Catherine M Quirk, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Ackerman Academy of Dermatopathology, New York

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous Chief Editor, William D. James, MD, to the development and writing of this article.

References

  1. Burgdorf W, Nasemann T. Cutaneous osteomas: a clinical and histopathologic review. Arch Dermatol Res. Dec 12 1977;260(2):121-35. [View Abstract]
  2. Roth SI, Stowell RE, Helwigeb. Cutaneous ossification. Report of 120 cases and review of the literature. Arch Pathol. Jul 1963;76:44-54. [View Abstract]
  3. Cohen PR, Tschen JA, Schulze KE, Martinelli PT, Nelson BR. Dermal plaques of the face and scalp. Platelike osteoma cutis. Arch Dermatol. Jan 2007;143(1):109-14. [View Abstract]
  4. 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. May 2011;52(2):127-31. [View Abstract]
  5. Riahi RR, Cohen PR. Multiple miliary osteoma cutis of the face after initiation of alendronate therapy for osteoporosis. Skinmed. Jul-Aug 2011;9(4):258-9. [View Abstract]
  6. Altman JF, Nehal KS, Busam KJ, Halpern AC. Treatment of primary miliary osteoma cutis with incision, curettage, and primary closure. J Am Acad Dermatol. Jan 2001;44(1):96-9. [View Abstract]
  7. 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. Oct 2011;13(5):227-30. [View Abstract]
  8. 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. Sep 2001;12(3):171-3. [View Abstract]
  9. 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. [View Abstract]
  10. Ragsdale BD. Lever's Histopathology of the Skin. Philadelphia, Pa: Lippincott-Raven; 1997:965-7.
  11. Watsky KL. Arndt KA, ed. Cutaneous Medicine and Surgery. Philadelphia, Pa: WB Saunders; 1996:1828-31.
  12. Weedon D, ed. Skin Pathology. 2nd ed. New York, NY: Churchill Livingstone; 2002:355-7.

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.

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.