Molluscum Contagiosum of the Nipple: A Case Report

Molluscum Contagiosum of the Nipple: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Molluscum Contagiosum of the Nipple: A Case Report Nupura Ajesh, Samiksha Ravindra Balaguragi, Poonam Sandeep Naphade, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7011677/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Purpose: Molluscum contagiosum (MC) is a common viral skin and mucosal dermatosis caused by molluscum contagiosum virus (MCV). It predominantly affects children, sexually active adults, and immunocompromised patients. Transmission occurs through direct contact with infected skin or autoinoculation and via contaminated objects. These lesions can appear in any part of the body and are presented as firm, round, non-tender, dome-shaped papules with sunken centres containing a white, curdy-type material. Although generally MC is self-limiting and benign, its occurrence on the nipple-areola complex is exceedingly rare, documenting less than 6 cases worldwide. Methods: We report a rare case of dermatosis of the nipple in a healthy 31-year-old female who presented with a 3-month, solitary, non-tender lesion on her right breast, with no similar lesions observed elsewhere on the body. She was referred to the plastic surgery department for further evaluation of breast carcinoma. Results: Upon recommendation, the lesion was excised and sent for histopathological examination, which confirmed the diagnosis of MC. Conclusions: Diagnosis of MC of the nipple is rare and often poses a clinical dilemma in treatment. Molluscum contagiosum nipple atypical lesion dermatosis of the nipple Henderson-Patterson bodies Figures Figure 1 Figure 2 Figure 3 Figure 4 1. INTRODUCTION MC is an acute viral-cutaneous infection caused by MCV, a double-stranded DNA virus in the Poxviridae family. Globally, around 8,000 individuals per 100,000 cases are affected annually. Its incidence is more frequently noted in children (> 90%) [ 1 ] while adult cases are uncommon; it often affects individuals who are sexually active or immunocompromised. The virus is self-limiting and is typically acquired through direct contact with an infected person or object [ 2 ]. MC presents as a firm, umbilicated, pink/skin colored papule measuring 2-5mm in diameter. Lesions in children are frequently seen on the face, trunk, and extremities or on the genitals of young adults, which are sexually transmitted. However, involvement of the breast, especially the nipple areolar area, is extremely rare and can mimic different pathologies like basal cell carcinoma or Paget’s disease[ 3 ]. 2. CASE A 31-year-old female dentist presented to the dermatologist with a persistent, 3-month, non-tender, painless nodular lesion on the nipple of the right breast (Fig. 1 ). She was diagnosed with folliculitis and was prescribed topical antibiotics, which showed no signs of clinical improvement over the months. Upon dermatological examination, she has no similar lesions elsewhere on her body, no family history of dermatological or breast conditions, and denied a history of sexual contact. To rule out the possibility of a breast neoplasm due to its unusual location and clinical presentation, she was then referred to a plastic surgeon. No mammographic imaging was done at this stage. A biopsy was taken from the lesion and sent for Histopathological Examination (HPE). Gross examination revealed lobulated epidermis showing hyperkeratosis, acanthosis, and parakeratosis. Keratinocytes showed large eosinophilic intracytoplasmic inclusions, which are characteristic of Molluscum contagiosum (MC). The surrounding tissue showed focal acute-on-chronic inflammatory infiltrates, with no evidence of malignancy (Figs. 2 , 3 ; Table 1 ). Table 1 SURGICAL PATHOLOGY REPORT Clinical History Complaints of growth over the right nipple since 2 weeks. Specimen Biopsy from the right nipple growth for Histopathology Examination. Gross Received in formalin. The specimen consists of two pale white soft tissue bits, each measuring 0.5 × 0.5 cm. All processed. Block 01. Microscopy Sections show skin tissue with lobulated epidermis demonstrating hyperkeratosis, acanthosis, and parakeratosis. Keratinocytes contain large eosinophilic intracytoplasmic inclusions. Surrounding tissue shows focal acute-on-chronic inflammatory infiltrate. No evidence of malignancy. Impression Biopsy from nipple growth: Molluscum contagiosum. No evidence of malignancy. Based on the histopathological findings, a final diagnosis of MC of the nipple was made, which is a rare and atypical presentation, especially in an immunocompetent woman without any risk factors or other lesions. Following the confirmation, complete excision of the lesion was done (Fig. 4 ). No further lesions were noted during follow-up. 3. DISCUSSION MC is a benign, self-limited viral infection that is caused by MCV, from the poxviridae family. They typically present as small, umbilicated, dome-shaped papules, which are more common in children, sexually active adults, and immunocompromised individuals[ 1 ]. It can be acquired from skin-to-skin contact or sexual contact. The current case is unique due to the unusual clinical presentation and location. A 31-year-old female developed a solitary painless nodular lesion of the right breast nipple, which persisted for around 3 months and was unresponsive to antibiotics. The unusual location and resistance to antibiotics led to further investigations. Histopathological examination revealed hyperkeratosis, acanthosis, and large eosinophilic intracytoplasmic inclusions within keratinocytes (Henderson-Patterson bodies), which confirmed the diagnosis. MC of the nipple is extremely rare, usually attributed to Paget’s disease, and other benign and malignant causes like leiomyoma, leiomyosarcoma, basal cell carcinoma, nevoid areolar hyperkeratosis, and benign cutaneous lymphoid hyperplasia[ 3 – 5 ]. Typically, MC is rare at this site; when present, it is accompanied by lesions on other parts of the body as well. In our case, the lesion was solitary and limited to the nipple, which emphasises the challenge when MC occurs in isolation, leading to misdiagnosis. Breast localized MC can mimic malignancy, hence needing histopathological confirmation to avoid unnecessary interventions [ 6 ]. Diagnosis is based on clinical findings, dermoscopy, confocal microscopy, and skin biopsy, as well as histopathology can aid in the diagnosis of cases that are not clinically obvious [ 3 ]. Generally, no treatment is required for MC in the case of an immunocompetent individual, as it is self-limiting. Although treatment remains debatable, whether to leave the lesions untreated or intervene and no specific antiviral therapy is currently available, various interventions like cryotherapy, laser ablation, curettage, topic acids and alkalis and some topical agents such as cantharidin and imiquimod, can be used for cosmetic reasons, atypical locations, or persistent lesions [ 1 ]. In this case, surgical excision was done for diagnostic clarification and removal. Our case sheds light on the need to include MC in the differential diagnosis of atypical nodular lesions on the breast and the importance of histopathological examination to prevent misdiagnosis and unnecessary therapeutic interventions. 4. CONCLUSION Our case highlights a rare presentation of MC of the nipple in a healthy adult female, which shows the diagnostic challenge due to the atypical locations of a generally benign condition. MC mimics more serious breast pathologies, especially when isolated and unresponsive to conventional treatment, so it should be considered under the differentials of nipple and nipple areolar complex lesions. Histopathological evaluation is crucial for the correct diagnosis and to avoid unnecessary medical interventions. This case report highlights the importance of clinical examination, history, and broad diagnostic consideration, even when dealing with subtle skin lesions at unusual sites. Declarations 1. Funding (information that explains whether and by whom the research was supported) - No funding 2. Conflicts of interest/Competing interests (include appropriate disclosures) - No conflicts of interest 3. Ethics approval (include appropriate approvals or waivers) -The authors certify that they have obtained all appropriate patient consent. 4. Consent to participate (include appropriate statements) - The authors certify that they have obtained all appropriate patient consent. 5. Written Consent for publication (include appropriate statements) - The authors certify that they have obtained all appropriate patient consent. 6. Availability of data and material (data transparency) - Not applicable 7. Code availability (software application or custom code) - Not applicable 8. Authors' contributions - Nupura Ajesh and Samiksha Ravi wrote the main manuscript text and prepared the case description. All authors assisted with the literature review and manuscript editing. All authors reviewed and approved the final manuscript. References Shetty S, Nair PA. Molluscum Contagiosum - A Review. Indian J Dermatol Venereol Leprol. 2018 Nov-Dec;84(6):738-746. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6259538/ Falknor GW. Molluscum contagiosum virus infection in immunosuppressed patients. Clin Infect Dis. 2005 Aug 15;41(4):506-12. doi: 10.1086/431527. Available from:https://pubmed.ncbi.nlm.nih.gov/16060861/ Kumar P, Ranjan R, Yadav S, et al. Molluscum contagiosum: A clinicopathological study of 12 cases. Indian J Dermatol Venereol Leprol. 2013 Nov-Dec;79(6):844-9. Available from:https://pubmed.ncbi.nlm.nih.gov/23972567/ Al-Mashat F, Al-Mohareb F, Amer M. Molluscum Contagiosum of the Nipple. Med J DY Patil Univ. 2012;5(2):197-199. Available from:https://journals.lww.com/mjdy/fulltext/2012/05020/molluscum_contagiosum_of_nipple.17.aspx Debjani C, Singh M, Kanwar AJ. Atypical presentations of molluscum contagiosum: a report of three cases. Indian Dermatol Online J. 2023 Mar-Apr;14(2):194-197. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10086167/ Shukla S, Sharma A, Meena S. Molluscum contagiosum in HIV infection: a clinicopathological study. Indian J Dermatol. 2014 Jan-Feb;59(1):63. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4336666/ Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 01 Apr, 2026 Reviews received at journal 04 Feb, 2026 Reviewers agreed at journal 27 Jan, 2026 Reviewers agreed at journal 25 Jan, 2026 Reviews received at journal 25 Jan, 2026 Reviewers agreed at journal 25 Jan, 2026 Reviewers agreed at journal 16 Jul, 2025 Reviewers invited by journal 13 Jul, 2025 Editor assigned by journal 04 Jul, 2025 Submission checks completed at journal 04 Jul, 2025 First submitted to journal 30 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7011677","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":484691970,"identity":"0bd9722b-db86-4fbb-93c8-661b2f25c09f","order_by":0,"name":"Nupura Ajesh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4UlEQVRIiWNgGAWjYBADZgYGHsYHQAYPHylamA1AWthIsIiHTQJEEdRiLpF7TLqixo6dn//sscqvOXYybAzMDx/dwKPFckZemuSZY8nMkkDGbdltyUCHsRkb5+DRYnAjx0yygY2Z2eAGj9ltyW3MQC08bNKEtfyrZ7Y/f8asWHJbPZFaGtsOA0Mrx4zx47bDRGg58y7ZsrHvOLPEjRxjacZtx3nYmAn55XjuwZsN36qT+fvPGH78ua3anp+9+eFjfFqA0QEmk0EEM5jNjFc5QosdiGD8QVD1KBgFo2AUjEQAACpzQBSY30JmAAAAAElFTkSuQmCC","orcid":"","institution":"Tbilisi State Medical University","correspondingAuthor":true,"prefix":"","firstName":"Nupura","middleName":"","lastName":"Ajesh","suffix":""},{"id":484691972,"identity":"560b4919-2605-4744-a14a-f22227afc5e5","order_by":1,"name":"Samiksha Ravindra Balaguragi","email":"","orcid":"","institution":"Ivane Javakhishvili Tbilisi State University","correspondingAuthor":false,"prefix":"","firstName":"Samiksha","middleName":"Ravindra","lastName":"Balaguragi","suffix":""},{"id":484691973,"identity":"b26cfa02-7433-4084-a7f7-ac5895d07f31","order_by":2,"name":"Poonam Sandeep Naphade","email":"","orcid":"","institution":"† Pushp Superspeciality Clinic","correspondingAuthor":false,"prefix":"","firstName":"Poonam","middleName":"Sandeep","lastName":"Naphade","suffix":""},{"id":484691974,"identity":"55aa630e-ecea-406e-830b-f3ec1da0a52c","order_by":3,"name":"Nikhila Liz Aby","email":"","orcid":"","institution":"Georgian National University SEU","correspondingAuthor":false,"prefix":"","firstName":"Nikhila","middleName":"Liz","lastName":"Aby","suffix":""}],"badges":[],"createdAt":"2025-06-30 14:38:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7011677/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7011677/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86781541,"identity":"e0924b30-930c-4363-bf86-32eb07ba6b8a","added_by":"auto","created_at":"2025-07-15 13:31:51","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":870952,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA 31-year-old woman having a 3-month history of a non-tender solitary nodular lesion over the right nipple. Clinical photograph pre-operatively showing a dome-shaped, well-defined lesion on the nipple. No other lesions were noted elsewhere on the body\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Fig1A31yearoldwomanhavinga3monthhistoryofanontendersolitarynodularlesionovertherightnipple.Clinicalphotographpreoperativelyshowingadomeshapedwelldefinedlesion.png","url":"https://assets-eu.researchsquare.com/files/rs-7011677/v1/ca5539c94d98b3316150778f.png"},{"id":86780183,"identity":"a1817279-e6e1-469b-b7fe-d9a311fdba3b","added_by":"auto","created_at":"2025-07-15 13:15:51","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1942350,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eHistopathological image of molluscum contagiosum showing Henderson-Patterson bodies (black arrow) within enlarged keratinocytes and a characteristic cup-shaped epidermal lesion\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Fig2HistopathologicalimageofmolluscumcontagiosumshowingHendersonPattersonbodiesblackarrowwithinenlargedkeratinocytesandacharacteristiccupshapedepidermallesion.png","url":"https://assets-eu.researchsquare.com/files/rs-7011677/v1/bda6b3676262d28681f14223.png"},{"id":86780188,"identity":"1fe14a95-843c-4a4e-b280-28f48a3501a2","added_by":"auto","created_at":"2025-07-15 13:15:51","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1974834,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eHistopathological examination with haematoxylin and eosin stain of molluscum contagiosum showing large intracytoplasmic Henderson-Patterson bodies (black arrow) and a cup-shaped epidermal invagination (red arrow)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Fig3HistopathologicalexaminationwithhaematoxylinandeosinstainofmolluscumcontagiosumshowinglargeintracytoplasmicHendersonPattersonbodiesblackarrowandacupshapedepidermal.png","url":"https://assets-eu.researchsquare.com/files/rs-7011677/v1/6568bfc15a513dea4f8c21dd.png"},{"id":86780197,"identity":"bc6e474a-e500-40d1-8949-7fac6a20ad41","added_by":"auto","created_at":"2025-07-15 13:15:52","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":735814,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eClinical photograph taken postoperatively during follow-up, showing the right nipple following complete surgical excision of the lesion. The site is noted to be healed with no recurrence or residual lesion\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Fig4Clinicalphotographtakenpostoperativelyduringfollowupshowingtherightnipplefollowingcompletesurgicalexcisionofthelesion.Thesiteisnotedtobehealedwithnorecurrenceorresid.png","url":"https://assets-eu.researchsquare.com/files/rs-7011677/v1/f7f9ab0442ac89cac30e2059.png"},{"id":86781544,"identity":"db159613-ec42-4986-80a4-38894d004cb5","added_by":"auto","created_at":"2025-07-15 13:31:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":7240012,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7011677/v1/cff9ccc1-8fb6-4306-a758-3b560f7dd791.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Molluscum Contagiosum of the Nipple: A Case Report","fulltext":[{"header":"1. INTRODUCTION","content":"\u003cp\u003eMC is an acute viral-cutaneous infection caused by MCV, a double-stranded DNA virus in the Poxviridae family. Globally, around 8,000 individuals per 100,000 cases are affected annually. Its incidence is more frequently noted in children (\u0026gt;\u0026thinsp;90%) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] while adult cases are uncommon; it often affects individuals who are sexually active or immunocompromised. The virus is self-limiting and is typically acquired through direct contact with an infected person or object [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. MC presents as a firm, umbilicated, pink/skin colored papule measuring 2-5mm in diameter. Lesions in children are frequently seen on the face, trunk, and extremities or on the genitals of young adults, which are sexually transmitted. However, involvement of the breast, especially the nipple areolar area, is extremely rare and can mimic different pathologies like basal cell carcinoma or Paget\u0026rsquo;s disease[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e"},{"header":"2. CASE","content":"\u003cp\u003eA 31-year-old female dentist presented to the dermatologist with a persistent, 3-month, non-tender, painless nodular lesion on the nipple of the right breast (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eShe was diagnosed with folliculitis and was prescribed topical antibiotics, which showed no signs of clinical improvement over the months. Upon dermatological examination, she has no similar lesions elsewhere on her body, no family history of dermatological or breast conditions, and denied a history of sexual contact.\u003c/p\u003e\u003cp\u003eTo rule out the possibility of a breast neoplasm due to its unusual location and clinical presentation, she was then referred to a plastic surgeon. No mammographic imaging was done at this stage. A biopsy was taken from the lesion and sent for Histopathological Examination (HPE). Gross examination revealed lobulated epidermis showing hyperkeratosis, acanthosis, and parakeratosis. Keratinocytes showed large eosinophilic intracytoplasmic inclusions, which are characteristic of Molluscum contagiosum (MC). The surrounding tissue showed focal acute-on-chronic inflammatory infiltrates, with no evidence of malignancy (Figs.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e; Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSURGICAL PATHOLOGY REPORT\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinical History\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eComplaints of growth over the right nipple since 2 weeks.\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpecimen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBiopsy from the right nipple growth for Histopathology Examination.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGross\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReceived in formalin. The specimen consists of two pale white soft tissue bits, each measuring 0.5 \u0026times; 0.5 cm. All processed. Block 01.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMicroscopy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSections show skin tissue with lobulated epidermis demonstrating hyperkeratosis, acanthosis, and parakeratosis. Keratinocytes contain large eosinophilic intracytoplasmic inclusions. Surrounding tissue shows focal acute-on-chronic inflammatory infiltrate. No evidence of malignancy.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImpression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBiopsy from nipple growth:\u003c/p\u003e\u003cp\u003eMolluscum contagiosum.\u003c/p\u003e\u003cp\u003eNo evidence of malignancy.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eBased on the histopathological findings, a final diagnosis of MC of the nipple was made, which is a rare and atypical presentation, especially in an immunocompetent woman without any risk factors or other lesions. Following the confirmation, complete excision of the lesion was done (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). No further lesions were noted during follow-up.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"3. DISCUSSION","content":"\u003cp\u003eMC is a benign, self-limited viral infection that is caused by MCV, from the poxviridae family. They typically present as small, umbilicated, dome-shaped papules, which are more common in children, sexually active adults, and immunocompromised individuals[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It can be acquired from skin-to-skin contact or sexual contact.\u003c/p\u003e\u003cp\u003eThe current case is unique due to the unusual clinical presentation and location.\u003c/p\u003e\u003cp\u003eA 31-year-old female developed a solitary painless nodular lesion of the right breast nipple, which persisted for around 3 months and was unresponsive to antibiotics. The unusual location and resistance to antibiotics led to further investigations. Histopathological examination revealed hyperkeratosis, acanthosis, and large eosinophilic intracytoplasmic inclusions within keratinocytes (Henderson-Patterson bodies), which confirmed the diagnosis.\u003c/p\u003e\u003cp\u003eMC of the nipple is extremely rare, usually attributed to Paget\u0026rsquo;s disease, and other benign and malignant causes like leiomyoma, leiomyosarcoma, basal cell carcinoma, nevoid areolar hyperkeratosis, and benign cutaneous lymphoid hyperplasia[\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Typically, MC is rare at this site; when present, it is accompanied by lesions on other parts of the body as well. In our case, the lesion was solitary and limited to the nipple, which emphasises the challenge when MC occurs in isolation, leading to misdiagnosis.\u003c/p\u003e\u003cp\u003eBreast localized MC can mimic malignancy, hence needing histopathological confirmation to avoid unnecessary interventions [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDiagnosis is based on clinical findings, dermoscopy, confocal microscopy, and skin biopsy, as well as histopathology can aid in the diagnosis of cases that are not clinically obvious [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eGenerally, no treatment is required for MC in the case of an immunocompetent individual, as it is self-limiting. Although treatment remains debatable, whether to leave the lesions untreated or intervene and no specific antiviral therapy is currently available, various interventions like cryotherapy, laser ablation, curettage, topic acids and alkalis and some topical agents such as cantharidin and imiquimod, can be used for cosmetic reasons, atypical locations, or persistent lesions [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In this case, surgical excision was done for diagnostic clarification and removal. Our case sheds light on the need to include MC in the differential diagnosis of atypical nodular lesions on the breast and the importance of histopathological examination to prevent misdiagnosis and unnecessary therapeutic interventions.\u003c/p\u003e"},{"header":"4. CONCLUSION","content":"\u003cp\u003eOur case highlights a rare presentation of MC of the nipple in a healthy adult female, which shows the diagnostic challenge due to the atypical locations of a generally benign condition. MC mimics more serious breast pathologies, especially when isolated and unresponsive to conventional treatment, so it should be considered under the differentials of nipple and nipple areolar complex lesions. Histopathological evaluation is crucial for the correct diagnosis and to avoid unnecessary medical interventions. This case report highlights the importance of clinical examination, history, and broad diagnostic consideration, even when dealing with subtle skin lesions at unusual sites.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e1. Funding (information that explains whether and by whom the research was supported) - No funding\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2. Conflicts of interest/Competing interests (include appropriate disclosures) - No conflicts of interest\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3. Ethics approval (include appropriate approvals or waivers) -The authors certify that they have obtained all appropriate patient consent.\u003c/p\u003e\n\u003cp\u003e4. Consent to participate (include appropriate statements) - The authors certify that they have obtained all appropriate patient consent.\u003c/p\u003e\n\u003cp\u003e5. Written Consent for publication (include appropriate statements) - The authors certify that they have obtained all appropriate patient consent.\u003c/p\u003e\n\u003cp\u003e6. Availability of data and material (data transparency) - Not applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e7. Code availability (software application or custom code) - \u0026nbsp;Not applicable\u003c/p\u003e\n\u003cp\u003e8. Authors' contributions - Nupura Ajesh and Samiksha Ravi wrote the main manuscript text and prepared the case description. All authors assisted with the literature review and manuscript editing. All authors reviewed and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eShetty S, Nair PA. Molluscum Contagiosum - A Review. Indian J Dermatol Venereol Leprol. 2018 Nov-Dec;84(6):738-746. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6259538/\u003cbr\u003e\u003c/li\u003e\n\u003cli\u003eFalknor GW. Molluscum contagiosum virus infection in immunosuppressed patients. Clin Infect Dis. 2005 Aug 15;41(4):506-12. doi: 10.1086/431527. Available from:https://pubmed.ncbi.nlm.nih.gov/16060861/\u003cbr\u003e\u003c/li\u003e\n\u003cli\u003eKumar P, Ranjan R, Yadav S, et al. Molluscum contagiosum: A clinicopathological study of 12 cases. Indian J Dermatol Venereol Leprol. 2013 Nov-Dec;79(6):844-9. Available from:https://pubmed.ncbi.nlm.nih.gov/23972567/\u003cbr\u003e\u003c/li\u003e\n\u003cli\u003eAl-Mashat F, Al-Mohareb F, Amer M. Molluscum Contagiosum of the Nipple. Med J DY Patil Univ. 2012;5(2):197-199. Available from:https://journals.lww.com/mjdy/fulltext/2012/05020/molluscum_contagiosum_of_nipple.17.aspx\u003cbr\u003e\u003c/li\u003e\n\u003cli\u003eDebjani C, Singh M, Kanwar AJ. Atypical presentations of molluscum contagiosum: a report of three cases. Indian Dermatol Online J. 2023 Mar-Apr;14(2):194-197. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10086167/\u003cbr\u003e\u003c/li\u003e\n\u003cli\u003eShukla S, Sharma A, Meena S. Molluscum contagiosum in HIV infection: a clinicopathological study. Indian J Dermatol. 2014 Jan-Feb;59(1):63. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4336666/\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"sn-comprehensive-clinical-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sncm","sideBox":"Learn more about [SN Comprehensive Clinical Medicine](https://www.springer.com/journal/42399)","snPcode":"42399","submissionUrl":"https://submission.nature.com/new-submission/42399/3","title":"SN Comprehensive Clinical Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Molluscum contagiosum, nipple, atypical lesion, dermatosis of the nipple, Henderson-Patterson bodies","lastPublishedDoi":"10.21203/rs.3.rs-7011677/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7011677/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003ePurpose:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMolluscum contagiosum (MC) is a common viral skin and mucosal dermatosis caused by molluscum contagiosum virus (MCV). It predominantly affects children, sexually active adults, and immunocompromised patients. Transmission occurs through direct contact with infected skin or autoinoculation and via contaminated objects. These lesions can appear in any part of the body and are presented as firm, round, non-tender, dome-shaped papules with sunken centres containing a white, curdy-type material. Although generally MC is self-limiting and benign, its occurrence on the nipple-areola complex is exceedingly rare, documenting less than 6 cases worldwide.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWe report a rare case of dermatosis of the nipple in a healthy 31-year-old female who presented with a 3-month, solitary, non-tender lesion on her right breast, with no similar lesions observed elsewhere on the body. She was referred to the plastic surgery department for further evaluation of breast carcinoma.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eUpon recommendation, the lesion was excised and sent for histopathological examination, which confirmed the diagnosis of MC.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDiagnosis of MC of the nipple is rare and often poses a clinical dilemma in treatment.\u003c/p\u003e","manuscriptTitle":"Molluscum Contagiosum of the Nipple: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-15 13:15:47","doi":"10.21203/rs.3.rs-7011677/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-01T09:53:44+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-04T09:11:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"5655237672818622693180016133088214989","date":"2026-01-27T05:40:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"288617364328941815986370300869545285488","date":"2026-01-25T13:38:45+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-25T10:24:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"46880681988416325650300316829265478077","date":"2026-01-25T09:46:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"234360537039362513544238972768362561469","date":"2025-07-16T10:55:44+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-13T15:00:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-04T05:25:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-04T04:21:07+00:00","index":"","fulltext":""},{"type":"submitted","content":"SN Comprehensive Clinical Medicine","date":"2025-06-30T14:24:07+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"sn-comprehensive-clinical-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sncm","sideBox":"Learn more about [SN Comprehensive Clinical Medicine](https://www.springer.com/journal/42399)","snPcode":"42399","submissionUrl":"https://submission.nature.com/new-submission/42399/3","title":"SN Comprehensive Clinical Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"f1e3a5ac-ed5d-41d6-8a3d-33dd79543fea","owner":[],"postedDate":"July 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-07T09:25:19+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-15 13:15:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7011677","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7011677","identity":"rs-7011677","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}