A polypous carbuncle

A carbuncle usually presents as a deep-seated mass of fistulous tracts between infected hair follicles. We present a case in which what appeared to be an inflamed, benign neoplasm turned out to be a very unusual presentation for this condition, the first we could find in the literature. A 62-year-old woman presented with a bothersome 'mole' on her flank of uncertain duration but it was initially pruritic and irritated by her clothing. Owing to the pain, she wanted its removal. A 1 cm soft, pink, stalked papule revealed multiple, closed,, comedo-like spots on its surface (Fig. 1). The lesion was mildly tender and freely mobile on a broad-based stalk. A pre-biopsy diagnosis of irritated intradermal nevus or neurofibroma was made, and the lesion was blade-shaved flush with the skin surface. Histologically, the papule demonstrated small abscesses which seemed to connect, as well as foci of granulation tissue and marked dermal edema (Fig. 2). Fragments of infundibular epidermis were found throughout the lesion. No residual melanocytic or neural neoplasms were identified.