An Update on the Clinical Management of Cutaneous Molluscum Contagiosum

Harrison P. Nguyen, BA; Stephen K. Tyring, MD, PhD, MBA

Disclosures

Skin Therapy Letter. 2014;19(2) 

In This Article

Diagnosis

The morphological appearance of molluscum contagiosum in most cases is sufficiently distinct to make a clinical diagnosis. However, some cases can be more challenging. Using a magnifying lens or a dermatoscope to visualize the characteristic central umbilication often aids in diagnosis. If the magnifying lens does not yield a conclusive diagnosis, the clinician can biopsy the lesion and conduct either histopathological studies or polymerase chain reaction (PCR) methods. Histopathology typically demonstrates epidermal hyperplasia producing a crater filled with molluscum bodies. Molluscum bodies, which are huge (up to 35 microns) discrete ovoid intracytoplasmic inclusion bodies, appear as large acidophilic granular masses, pushing the nucleus and numerous keratohyaline granules aside. Although identification of molluscum bodies is conclusive for diagnosis of molluscum contagiosum, molluscum bodies can be sparse and difficult to visualize in some densely inflamed lesions. Intact lesions display little inflammation while ruptured lesions show a mixed inflammatory response characterized by mononuclear cells, neutrophils, and multinucleated giant cells. Brick-shaped virions can usually be seen through negative-stain transmission electron microscopy.[15]

Molluscum contagiosum can bear similar clinical presentation to other disorders. Rarely, they may be confused with warts and, if located on the genitalia, may be mistaken for condyloma of a human papillomavirus infection.[27] Giant molluscum nodules can resemble basal cell epithelioma, keratoacanthoma, verruca vulgaris, condyloma acuminatum, or a warty dyskeratoma.[28]

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