Perforating calcifying epithelioma of Malherbe with a rapid evolution

A very rare case of calcifying epithelioma of Malherbe (CEM) with a rapid evolution and perforation of the epidermis is reported. Clinical appearance was atypical and did not suggest any diagnosis. Histopathologic examination shows a picture of CEM with some peculiar findings. Furthermore, in the upper dermis there are epithelial strands of shadow cells, partially calcified, tending to come in contact with the perforated epidermis and to be eliminated through it. The acute form of CEM and the mechanism of epidermal perforation in perforating dermatoses are discussed.