In its typical clinical appearance of a circinate ring of individual or
Central necrobiosis surrounded by palisading histiocytes (hematoxylin-eosin, ×100).
confluent dermal papules, granuloma annulare is readily identified by the trained observer. However, an unusual subcutaneous form of granuloma annulare is recognized,1 occurring especially in children, that may mimic soft tissue tumors.
Report of a Case.—An 11-year-old girl was seen in the Outpatient Dermatology Clinic of the University of Michigan Hospital with a seven-year history of slowly enlarging soft tumors of the ankles bilaterally. These tumors were nontender but had distorted the anatomy of each ankle to approximately twice normal size and produced a minimal compromise of function. As the child grew older, they were of increasing cosmetic concern. She was otherwise in good health.
A biopsy specimen was obtained using a deep elliptical excision at a right angle to the long axis of the tumor. Histological evaluation