Unmasking molluscum contagiosum: Navigating atypical presentations in a clinical mosaic

Molluscum contagiosum is a poxvirus-mediated, highly contagious infection predominantly affecting the face, trunk, and extremities of children and young adults. Although typically characterized by flesh-colored papules with central umbilication, atypical presentations, particularly in immunosuppressed and HIV-infected individuals pose diagnostic challenges. This retrospective study, spanning from January 2013 to January 2016, examined 19 cases of molluscum contagiosum, emphasizing unusual clinical and histopathological features. Three atypical cases were identified, including a 24-year-old female with a subcutaneous lump on the left areola, a 34-year-old male with genital lesions resembling lichen nitidus, and a 17-year-old male with a cystic scalp swelling. Histopathological examination confirmed molluscum contagiosum in all cases, revealing characteristic eosinophilic inclusions within squamous cells. Notably, the study expands the understanding of atypical presentations, such as lesions on the areola and cystic forms, which are infrequently reported in the literature. Despite the absence of immunosuppression or HIV infection in the atypical cases, the study highlights the need for clinicians to consider molluscum contagiosum in diverse clinical scenarios. The accurate diagnosis, often requiring biopsy or cytology, underscores the importance of histopathological evaluation in guiding appropriate treatment strategies, including surgical excision or topical antiviral agents. Overall, these case reports contribute valuable insights into the varied manifestations of molluscum contagiosum, emphasizing the necessity for vigilance in recognizing atypical presentations.