The diagnostic biopsy specimen (Figure 3) showed mature bone within the dermis. Higher magnification (Figure 4) confirmed that both osteocytes and osteoblasts were present.
No more lesions have developed in the 6 months since the patient presented. We removed 15 of them with the patient under local anesthetic by incision over the bone, which was then lifted up with a needle bent to form a skin hook, grasped with forceps, and removed by cuffing of the surrounding fibrous tissue. The removed bone was brown (Figure 5). One 5/0 polyamide (Ethilon) suture was used to close each wound. The patient is delighted with the cosmetic result and keen to have all the larger lesions removed in this way.
Blue Facial Nodules. Arch Dermatol. 1998;134(7):861-866. doi: