43-year-old woman presented in June 2013 with 6-month history of 1 cm forehead nodule that appeared during pregnancy. The soft lesion fluctuated in size according to the patient. Excisional biopsy performed on 6/1/17 revealed chronic granulomatous inflammation around refractile foreign material. The lesion appeared to be recurring 2 weeks post-operatively.
Foreign body granuloma without a history of pre-existing injury or foreign body inoculation is a curiosity. The areas of the forehead where injury from childhood often occur is a common location. Sand and silica particles can be embedded subcutaneously from a simple abrasion. Foreign body granulomas appearing many years later, is a possibility. Such may be the case in our patient. However without a history of injury, sarcoid should be considered. Cases of sarcoid lesions developing within a scar may have a similar histologic appearance. In this case, the birefringent silica particles are diagnostic of a previous injury.