Letter to the Editor

The paper of Dare and Axelsen on scrotal caleinosis is well documented and nicely illustrated; however their assertion concerning the epithelial origin of the calcified nodules warrants further comment (1). Some years ago we summarized in 2 papers an extensive search for the primum movens of the disease in 3 adults (2, 3); later we had the opportunity of investigating other cases. Large numbers of calcified nodules from diagnostic biopsies and therapeutic excisions were scrutinized in semi-serial sections for epithelial or vascular connexions and for necrotizing tissues; it has proved impossible to find any epithelial remnant, however tiny, around or within the giant cell palissading granuloma. These contradictory findings allow speculation that: 1) distinct mechanisms might induce similar, and peculiar, calcium deposits and foreign body granuloma within the scrotal skin; 2) nodules devoid of epithelial debris might represent old deposits after the epithelial component had had time to decay and disappear, even if they were of very small diameter. Nevertheless, after an extensive investigation this looks quite inconvenient from the statistical point of view. So far, it seems logical to accept long-term convergence of different mechanisms until new and large numbers of cases have been documented.