IH Jun, et al. Calcinosis Cutis at the Tarsus of the Upper Eyelid A B Fig. 2. Histopathologic finding of the tarsal lesion. (A) Low power view of the lesion (H&E, ×12) with a significant amount of amorphous calcium material (stained pink) and multiple calcium crystals (stained purple). (B) High power view showing the calcium crystals in the lesion (H&E, ×100). Arrow, calcium crystal; arrow head, tarsal epithelium. injection of the left eye was noted, but the cornea was clear. The laboratory data showed no abnormalities. Serum calcium and phosphorous levels were also normal. On inspection, the left eyelid was slightly elevated, and a hard, palpable mass was detected in the upper eyelid. Everting the upper eyelid revealed a large papillomatous mass attached to the upper margin of the tarsus (Fig. 1). As the patient did not want to risk possible disfigurement with a complete excision, the protruding mass above the tar- sal border was partially debulked at the conjunctival side under local anesthesia, and was sent to the pathology de- partment where it was identified as calcinosis cutis. Fig. 2 shows a massive amorphous calcium material beneath the epithelial lining and basophilic-stained crystallized calcifi- cation deposits. The normal tarsus tissue was scarcely present. Discussion Calcinosis cutis is pathologically defined as the deposition of calcium material beneath the epithelial lining. It mostly affects patients with connective tissue disorders, such as dermatomyositis, systemic lupus erythematosis, or systemic sclerosis [3]. Other types of calcifications, such as band ker- atopathy, bulbar calcification, or palpebral, conjunctival, or eyelid calcification, have been reported in patients with oc- ular inflammation, systemic hyperparathyroidism, or hy- perphosphatemia [5,7]. However, in this case, the patient had normal serum levels of calcium and phosphate, and no previous systemic or trauma history. Based upon this in- formation, this case represents the first incidence of idio- pathic calcinosis cutis affecting the tarsus of the eyelid. No standard treatment has been recommended for the removal or reduction of the lesion in cases of calcinosis cutis [3,8]. Colchicine, warfarin, bisphosphonates, probenecid, and dil- tiazem have been used with varying degrees of success [8]. Carbon dioxide laser therapy, minocycline [9], salicylates, and aluminum hydroxide could also be used. The afore- mentioned treatments were only used for skin lesions, dem- onstrating limited efficiency. Therefore, surgical excision for a large protruding mass of calcinosis cutis might be the best option. In this case, we performed partial debulking of the le- sion, and more follow-up is required to monitor for regrowth. If the regrowth occurs rapidly, complete excision with free margin control will be necessary. However, such a decision would not be easy, as the base of the lesion is quite broad, in- cluding the normal tissue of the tarsus, and more importantly, the patient does not feel much irritation from this lesion. Complete excision might cause a serious cosmetic disfigure- ment or discomfort. Clinicians should consider calcinosis cutis in the differ- ential diagnosis of papillomatous mass lesions involving the tarsus. Conflict of Interest No potential conflict of interest relevant to this article was reported. References 1. Llamas-Velasco M, Eguren C, Santiago D, et al. Calcinosis cu- tis and Sjogren's syndrome. Lupus 2010;19:762-4. 2. Goldminz D, Barnhill R, McGuire J, Stenn KS. Calcinosis cu- tis following extravasation of calcium chloride. Arch Dermatol 1988;124:922-5. 3. Boulman N, Slobodin G, Rozenbaum M, Rosner I. Calcinosis in rheumatic diseases. Semin Arthritis Rheum 2005;34:805-12. 4. Tristano AG, Villarroel JL, Rodriguez MA, Millan A. Calcinosis cutis universalis in a patient with systemic lupus erythematosus. Clin Rheumatol 2006;25:70-4. 5. Ferry AP. Subepidermal calcified nodules of the eyelid. Am J Ophthalmol 1990;109:85-8. 6. Klauber S, Heegaard S, Prause JU. Primary palpebral and or- bital ossification in pseudo-pseudohypoparathyroidism. Acta Ophthalmol Scand 2002;80:543-5. 441