DX: Necrobiotic Xanthogranuloma

The first approach was to establish 2 or 3 differentials. The first one on my mind was Plexiform Neurofibromatosis that usually deforms face or skin. Other dermatologic conditions such as Keratoderma or Liquenoid keratosis are to be considered. This is why a good communication with the Dermatologist can be very helpful. A biopsy was conducted prior to reconstructive surgery.

Final diagnosis: Necrobiotic Xanthogranuloma

Necrobiotic xanthogranuloma is a rare disease, usually associated with a monoclonal gammapathy. It can affect skin mostly but organ involvement are reported.

On the left (A) a coronal reconstruction of my patient. On the right (B), a picture of a patient with similar skin nodules reported in a paper online (Girisha BS, Holla AP, Fernandes M, Noronha TM. Necrobiotic xanthogranuloma. J Cutan Aesthet Surg [serial online] 2012 [cited 2014 May 30];5:43-5. Available from: http://www.jcasonline.com/text.asp?2012/5/1/43/94341)



These are other examples:

http://www.ncbi.nlm.nih.gov/pubmed/12746671

http://www.ncbi.nlm.nih.gov/pubmed/19289757



Hope this was helpful, feel free to comment.