Tuesday, April 14, 2015

Giant Molluscum

Presented by Henry Foong
Ipoh, Malaysia

The patient is a one year old child with a four week history of a giant molluscum on the lower eyelid. There are a few smaller papules on the trunk; but the solitary lesion pictured below is therapeutically challenging. 

I tried to curette it but was unsuccessful as the child was very fretful.
What suggestions do you have any other method of removing this?
There are many clinical reports of giant molluscum associated with HIV.  Would you test this child for that?
Your suggestions will be helpful.


  1. James C. Shaw, MDApril 14, 2015

    The size, singularity and dome shape are within the normal range for molluscum. I think you can treat as such, though it might be somewhat difficult. The giant molluscum of immunosuppression usually are broad-based as if multiple lesions have coalesced.

  2. from Khalifa Sharquie (Baghdad): Molluscum contagiosum is running an epidemic state in Iraq. So we are seeing many cases a day with different morphological forms.We did clinical,pathological and therapeutic studies which are going to published soon.It is self limiting condition but should be treated to prevent its spread .The simple way of therapy is to do puncture of the lesions by orange stick dipped in 10%phenol once only that could be repeated after one week if the lesion did not clear .Puncturing the lesion will disturb the well organized architecture of the MC lesion and molluscum bodies inside the keratinocytes.

  3. from Brian Maurer (Tariffville, Connecticut):

    As molluscum is considered to be benign, we generally do not treat it aggressively in young children, except where it might be considered a cosmetic problem, as in this child. The challenge is that it lies close to the eye. One must be diligent to avoid the inadvertent instillation of topical medication into the eye. One remedy that seems to be effective is the topical administration of vinegar to the lesion at bedtime. Most lesions will diminish after 7 to 10 days of treatment.

    Unless there are myriad lesions, I would not elect to test this child for HIV.

  4. from Yoon Cohen, D.O. This is a challenging question.
    Because of the location, I would be hesitant to try any topicals ass they will probably rub into the eye. Also, I don't see how we can do any procedures with local anesthesia in this age group because of the location.
    Please see a few recommendations from a literature-textbook review:

    From the pediatric derm textbook:
    "Treatment of periocular MC is especially difficult because the use of vesicants, irritants, or sharp instruments near the eye of a young child is fraught with danger. In this situation, observation without treatment is usually justified unless symptomatic conjunctivitis is present, in which case removal of the lesion while the patient is under a general anesthetic may be necessary."

    Another source:
    J Pediatr Ophthalmol Strabismus. 1983 Jan-Feb;20(1):19-21.
    Management of periocular molluscum contagiosum in children. Margo C, Katz NN.
    Because there are no data concerning the association between periocular molluscum contagiosum (POMC) and toxic conjunctivitis, and since there are no established guidelines of acceptable treatment, we surveyed pediatric ophthalmologists in North America in order to analyze the results of their cumulative experience dealing with the disease. Approximately half of 341 cases of POMC were not associated with conjunctivitis; however the majority of cases were treated, occasionally with chemical ablatives or cautery. Many ophthalmologists preferred to use general anesthesia in the treatment of POMC. POMC was noted not only to regress spontaneously, but was also noted to recur after treatment. Because of the benign nature of the infection, indications to treat asymptomatic POMC are not clearly established.


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