Granuloma Caused by Carbon Deposition in the Dermis

Abstract EN

Pencil core granuloma is characterized by a delayed foreign-body reaction against retained fragments of pencil lead.

Previous case reports presented pencil core granuloma resembling malignant melanoma, haemangioma, or soft tissue sarcoma.

We present a case of pencil core granuloma arising from the palm 25 years after the initial injury.

The patient presented a bluish nodule that had been present over 25 years before.

The nodule initially measured 5 mm in diameter.

However, five years before presentation, it suddenly enlarged to the size of 30 mm during six months.

Computed tomography (CT) of the lesion revealed a linear radiopaque structure of 8 mm long with a mass on its distal end.

Surgical resection revealed a bluish muddy mass and pencil lead.

Histological examination revealed degenerative tissue with calcification surrounded by massive amounts of black granular material in the middle and lower dermis.