A foreign body is any live or inanimate material introduced in the human body, and the body responds by using its mechanisms of defense. Although a broad definition would also include microorganisms that elicit an immune response, foreign bodies are usually considered to be inorganic compounds or high-molecular-weight organic materials that resist destruction by inflammatory cells.1 These substances can enter iatrogenically during surgical procedures, as is the case with foreign body reactions to suture material.2

We describe an 87-year-old man with a history of prostate cancer, atrial fibrillation, hypertension, and chronic bronchitis who had undergone surgery 30years earlier for a malignant neoplastic process classified by the hospital at the time as nasal natural killer lymphoma; no further information was available. In March2010 the patient consulted for an excrescent mass from 5months previously that was present on the nasal bridge, on top of an old scar. The examination revealed an erythematous, pearly plaque with a maximum diameter of 1.5cm adherent to the deep layer (Fig. 1), and dermoscopy showed spider telangiectasia and grayish-blue areas.

Figure 1.

A,pearly papule of 1.5cm in diameter over the previous scar. B,surgical specimen containing the steel suture wire.

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Because basal cell carcinoma was suspected, the lesion was biopsied to rule out recurrence of the lymphoproliferative process, at which time a stainless steel suture wire was found (Fig. 1).

On further questioning, the patient reported that a bone autograft from the hip had been used in one of the previous nasal reconstruction operations. The x-ray showed other suture wires used to fix an abnormal bone structure that corresponded to the hip graft used for nasal reconstruction (Fig. 2).

Figure 2.

Autograft radiography. Radiopaque suture wire and hip graft used to replace the normal nasal anatomy.

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Histology revealed the presence of a diffuse inflammatory infiltrate in the dermis, composed predominantly of plasma cells, lymphocytes, and occasional multinucleated giant cells (Fig. 3). No epidermal involvement or well-formed granulomas were observed. Lymphoid cells showed no atypia, and immunohistochemistry ruled out any recurrence of a lymphoid neoplasm. Removal of the wire and direct suture during the biopsy resolved the symptoms.

Figure 3.

A,diffuse inflammatory infiltrate in the dermis. Epidermis with no significant histologic abnormalities (hematoxylin-eosin, original magnification, x25). B,lymphoplasmacytic inflammatory infiltrate containing isolated multinucleated giant cells (hematoxylin-eosin, original magnification, x200).

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Stainless steel is sufficiently strong, flexible, ductile, and biocompatible to be used in most maxillofacial implants.3 The material is also inexpensive and easy to handle and, therefore, has been frequently used in needles, wires, and plates for reconstructive surgery of the facial region. In implants, it has now been replaced with other materials, such as titanium.4

Foreign body reaction to stainless steel implants is rare. Deterioration of the wire used in sternotomy reconstruction has been reported, however.5 In these cases, the reaction appeared in the months after surgery and the patients consulted for atypical chest pain.

The appearance of a reaction 30years after the wire was implanted is also rare, and cannot be explained by the patient's history, as there were no injuries or recent procedures in the area. Moreover, the patient did not wear glasses or use an oxygen mask. In 2006 Surov et al6 described a similar case of delayed reaction in an 84-year-old man with a World War II grenade injury 60years previously who developed a mass in the area caused by a foreign body reaction to steel fragments from the weapon.

Our letter describes a new case of foreign body reaction to stainless steel wire 3 decades after implantation. In this patient the lesion resembled basal cell carcinoma. This case report is unusual in that the condition presented 30years after implantation with no previous triggering injury. Foreign body reaction should be included in the differential diagnosis of any skin process that develops over a surgical scar, even if the process takes place many years after the operation.