S104 Pearls J AM ACAD DERMATOL

MAY 2007

To overcome this potential difficulty, a simple
technique using the sharp edge of the disposable
ring curette is suggested. The curette is ideally held
as in the ‘‘fountain-pen technique,’’ and the margins
of the lesion to be curetted are delineated using the
sharp edge of the ring curette. The margins of small
lesions (6-7 mm) are gently scored by advancement
of the sharp edge of a 7-mm curette at one end to
another to include the entire specimen en bloc
(Fig 1, A-C ). Standard curettage and cautery technique
is employed thereafter. The ring of the curette can
be compressed to achieve a shape suited to the
thickness and size of the lesion to be curetted. For
bigger lesions ($1 cm), the curette can be easily
advanced from the margin to the center of the lesion
with a slicing movement to attain the specimen at a
desired depth. Advantages of this technique include
attainment of the en bloc specimen. This allows
laboratory technicians to cut serial sections of the
tissue and prevents failure of the fragmented tissue
from being processed, as may rarely be the case with
the standard curettage technique. Histopathologic
analysis is consequently easier and interpretation
convenient for the pathologists.
REFERENCES
1. Sheridan AT, Dawber RP. Curettage, electrosurgery and skin
cancer. Australas J Dermatol 2000;41:19-30.
2. Goldblum OM. Surgical pearl: the single-use, surgical curette
blade. J Am Acad Dermatol 2004;50:275-6.

Medical Pearl: Confirming the diagnosis of molluscum

contagiosum using 10% potassium hydroxide
Jacob H. Bauer, MD, O. Fred Miller, MD, and Steven J. Peckham, MD
Danville, Pennsylvania

M olluscum contagiosum characteristically

presents as a firm, flesh colored or pink,
waxy or pearly, dome-shaped umbilicated
papule, often with a central protruding core. The
papules can reach up to 1 cm in size. The virus
generally affects children, sexually active adults, and
immunocompromised patients.1 The diagnosis is
generally made on clinical grounds, but mollusca
may mimic benign nevi, fibrous papules, adnexal
tumors, basal cell carcinoma, keratoacanthoma,
juvenile xanthogranuloma, neurilemmoma, lichen
planus, milia, flat warts, granuloma annulare, pyo- Fig 1. Crushed molluscum core material. (Original mag-
genic granuloma, bacillary angiomatosis, cryptococ- nification: 34.)
cus, histoplasmosis, and Penicillium marneffei
infection.1-4 Traditionally, confirmation of diagnosis
requires a crush prep followed by Wright, Giemsa,
Gram, or Papanicolaou stain to visualize the mollus-
cum core material for the characteristic Hendersone

From Geisinger Medical Center.

Funding sources: None.
Conflicts of interest: None declared.
Correspondence to: Jacob H. Bauer, MD, Dermatology M.C. 14-06,
100 N Academy Ave, Danville, PA 17822. E-mail: jhbauer@
geisinger.edu.
J Am Acad Dermatol 2007;56:S104-5.
0190-9622/$32.00
ª 2007 by the American Academy of Dermatology, Inc. Fig 2. Clustered HendersonePatterson bodies. (Original
doi:10.1016/j.jaad.2006.08.045 magnification: 310.)
J AM ACAD DERMATOL
VOLUME 56, NUMBER 5
Fig 3. The uniform clustered appearance of Hendersone
Patterson bodies at higher magnification is distinctly dif-
ferent from the less densely-packed and less regular
appearance of epithelial cells. (Original magnification:
320.)
Paterson intracytoplasmic viral inclusion bodies.
Alternatively, hemotoxylineeosin stained formalin-
fixed tissue from a biopsy specimen will show these
same confirmatory features. In a research setting,
immunohistochemical or DNA in situ hybridization
techniques may be used to demonstrate presence of
the Mollusca virus.5,6
We propose a quick and reliable in-clinic method
to confirm the diagnosis of molluscum contagiosum
using the same 10% potassium hydroxide solution
Surgical Pearl: Alternate method of loading
needle to facilitate subcuticular suturing
Ammar M. Ahmed, BA,a and Ida Orengo, MDb
Houston, Texas
BACKGROUND
The subcuticular suture—first described by
Halsted in 1889 as a method of reducing wound
From the Baylor College of Medicine,a and the Director of the
Mohs Surgery Center and Professor of Dermatology,b Baylor
College of Medicine.
Funding sources: None.
Conflicts of interest: None declared.
Correspondence to: Ida Orengo, MD, Baylor College of Medicine,
6620 Main #1425, Houston, TX 77030. E-mail: iorengo@
bcm.edu.
J Am Acad Dermatol 2007;56:S105-6.
0190-9622/$32.00
ª 2007 by the American Academy of Dermatology, Inc.
doi:10.1016/j.jaad.2006.09.031
Pearls S105
that is routinely used to confirm the diagnosis of
superficial fungal infections. Following curettage of
a molluscum, the core material is crushed between
two glass slides, followed by application of 10%
potassium hydroxide solution and a cover slip.
Keratin will sufficiently ‘‘clear’’ within minutes, and
the clustered, round- or oval-shaped Hendersone
Paterson bodies are easily seen within the specimen
(Figs 1-3).
REFERENCES
1. Diven DG. An overview of poxviruses. J Am Acad Dermatol
2001;44:1-16.
2. Mancini AJ, Shani-Adir A. Other viral diseases. In: Bolognia JL,
Jorizzo JL, Rapini RP, editors. Dermatology. New York: Mosby;
2003. pp. 1266-8.
3. Kapembwa MS, Goolamali SK, Price A, Boyle S. Granuloma
annulare masquerading as molluscum contagiosumelike erup-
tion in an HIV-positive African woman. J Am Acad Dermatol
2003;49:184-6.
4. Nguyen K, Taylor S, Wanger A, Ali A, Rapini RP. A case of
Penicillium marneffei in a US hospital. J Am Acad Dermatol
2006;54:730-2.
5. Penneys NJ, Matsuo S, Mogollon R. The identification of
molluscum infection of immunohistochemical means. J Cutan
Pathol 1986;13:97-101.
6. Thompson CH, Biggs IM, DeZwart-Steffe RT. Detection of
molluscum contagiosum virus DNA by in-situ hybridization.
Pathol 1990;22:181-6.
infections1 and popularized by Davis2 a few decades
later for its cosmetic appeal—is a popular method of
wound closure and plays an important role in cuta-
neous surgery. Numerous techniques for subcuticu-
lar suturing have been described in the literature,
with variations in suture type and methods of suture
retention, including knot-free and buried-knot vari-
ations.3-9 The subcuticular stitch involves needle
throws parallel to the long axis of the wound, as
opposed to running or interrupted epidermal sutures
in which the throw is perpendicular to the long axis.
As such, there are unique wrist movements involved
in subcuticular suturing, and from our experience
the traditional method of gripping and maneuvering
the needle with the needle driver can cause the