A true molluscum pendulum

A 45-year-old man with epilepsy and mental retardation presented to the dermatology clinic with a "mole" on his nose and a "skin tag" on his scrotum. On examination, the patient had multiple, 2-3-mm, skin-colored, shiny papules in clusters about the perinasal region, and a large, pedunculated, soft, red tumor extending from the inferior aspect of the scrotum (Fig. 1). A shave biopsy from a nasolabial fold lesion and an excision of the pedunculated tumor were performed. The shave biopsy of the nose showed multiple exophytic papules containing blood vessels and fibrous tissue consistent with angiofibroma. The excision biopsy of the groin showed a large skin polyp with a central fibrovascular core. In addition, it revealed papillomatosis of the epidermis and dilated blood vessels, suggesting that the tumor was a molluscum pendulum seen in patients with tuberous sclerosis complex (Fig. 2). A Verhoff van Gieson stain demonstrated a lack of elastin fibers in the tumor (Fig. 3).