Other diagnoses to consider for nonhealing or treatment-resistant ulcers include infection (eg, bacterial, mycobacterial, fungal, or underlying osteomyelitis), vasculopathy (arterial insufficiency, venous stasis, atheroembolism, or diabetes mellitus), pyoderma gangrenosum, and malnutrition.
Because the diagnosis of osteoma cutis is made primarily by pathology, suspicious lesions should be biopsied.
Conservative Tx is a good approach
Case reports suggest that bone removal speeds healing, but the benefits of surgical intervention are unclear because healing is observed in patients who receive only conservative management.2,3,5 With lesions arising on the head and neck, treatment goals are usually aesthetic. Surgical techniques of resection, curettage, or dermabrasion are most often used, and topical retinoic acid has proven to be a helpful adjuvant therapy.7
No surgery for our patient
Given our patient’s history of trauma followed by recurrent ulceration (which may not have completely resolved), we suspected that chronic inflammation was the cause of the osteoma cutis.
We prescribed minocycline 100 mg BID for 14 days for superficial wound infection, with plans to extend treatment as needed based on wound healing. She also received care at a local wound clinic for incomplete resolution of the ulceration and biopsy sites. The patient was lost to follow-up.
CORRESPONDENCE
Sally P. Weaver, MD, PhD, McLennan County Medical Education and Research Foundation, 1600 Providence Drive, Waco, TX 76707; sallyweaver@me.com