CASE REPORT Incidental Idiopathic Calcinosis Cutis in a Rhytidectomy Patient HASAN METE A KSOY ,R AGIP O ¨ ZDEMIR,O ¨ NDER K ARAASLAN,YIGIT OZER T IFTIKCIOGLU, MELIKE ORUC ¸ , AND UGUR K OC ¸ ER Plastic and Reconstructive Surgery Clinic, Ankara Training and Research Hospital, Ankara, Turkey Calcinosis cutis, deposition of insoluble calcium salts in cuta- neous tissues, is an uncommon disorder. This condition can be classified as metastatic, dystrophic, idiopathic, and iatrogenic based on the pathogenesis of the deposition. Whereas dystroph- ic calcinosis cutis is a fairly common condition, idiopathic cases are very rare. Distinct cutaneous anatomic areas, the vulva, scrotum, penis, and breast, have been reported to develop this disorder. Nevertheless, our case who had idiopathic calcinosis cutis in her neck may be a proof that this condition is not con- fined to genitals or the breasts and can be seen all over the skin. HASAN METE AKSOY, RAGIP O ¨ ZDEMIR, O ¨ NDER KARAASLAN, YIGIT OZER TIFTIKCIOGLU, MELIKE ORUC ¸ , AND UGUR KOC ¸ER HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. CALCINOSIS CUTIS is an uncommon disorder and defined as the deposition of insoluble calcium salts in cutaneous tissues. This kind of deposition can be clas- sified into four major types: metastatic deposition, dystrophic deposition, idiopathic deposition, and iatrogenic deposition. 1 Whereas dystrophic calcinosis cutis is a fairly common condition, idiopathic cases are very rare. Because it is a very uncommon condition, it usually is a diagnosis of exclusion. Idiopathic ca- lcinosis cutis is caused by no underlying disease. 2 In the literature few cases have previously been reported with idiopathic calcinosis cutis. Several cutaneous an- atomic areas, the vulva, scrotum, penis, and breast, have been reported to develop this disorder. 2 Never- theless, our case who had idiopathic calcinosis cutis in her neck may be a proof that this condition is not confined to genitals or the breasts and can be seen all over the skin. Case Report A 62-year-old woman was admitted to our clinic to have an aesthetic rhytidectomy. She was generally healthy and did not have any complaints except the sagging of her neck (Figure 1). Aesthetic rhytidectomy (neck lift) was performed to address her complaints. As a routine part of the procedure an excess skin island of 3  9 cm in size was excised on both sides. The excised skin was macroscopically normal but was sent for routine pathologic examination. The postoperative period was uneventful. Interestingly, microscopic evaluation showed the presence of large calcium deposits in the dermis with no other pathology. The deposits were consistent in all the sections of the specimen. Microscopic examination with routine hematoxylin and eosin stain revealed large deposits of granular basophilic material in the deep dermis (Figure 2A). The calcium deposits were seen as localized areas surrounded with normal colla- gen fibers and healthy dermal tissue (Figure 2B). The result was reported as calcinosis cutis. The incidental diagnosis of calcinosis cutis necessi- tated further clinical and laboratory investigations. No abnormal clinical or laboratory findings, however, could be detected despite meticulous clinical examina- tion and a very detailed laboratory workup. The patient was satisfied with the postoperative result and no further treatment has been performed (Figure 3). Discussion Calcinosis cutis is defined as deposition of calcium within the skin and includes the following forms: met- astatic calcinosis, dystrophic calcinosis, idiopathic ca- lcinosis, subepidermal calcified nodule, and iatrogenic calcinosis. 3 Metastatic calcinosis is usually seen in normal ap- pearing skin in the presence of serum hypercalcemia or hyperphosphatemia. Causes include hypervitaminosis D, hyperparathyrodisim, chronic renal failure, milk alkali syndrome, sarcoidosis, and destructive bone diseases 4 Chronic renal insufficiency is the primary disease associated with metastatic calcification. r 2004 by the American Society for Dermatologic Surgery, Inc.  Published by Blackwell Publishing, Inc. ISSN: 1076-0512/04/$15.00/0  Dermatol Surg 2004;30:1145–1147 Address correspondence and reprint requests to: Ugur Koc ¸er, MD, Mesrutiyet Cad. 17/12, 06640 Kizilay, Ankara, Turkey, or e-mail: drtiftikcioglu@yahoo.com.