Giant Molluscum Pendulum of the Posterolateral Face of the Right Knee: About One Case and Review of the Literature

: A molluscum pendulum or fibroepithelial polyp is a benign and frequent cutaneous tumor formation, in the form of a polyp, which forms a pedunculated growth. They usually develop in the neck, armpits or groin.


Introduction
A molluscum pendulum or fibroepithelial polyp (Gaurav & Grover, 2021) is a benign and frequent cutaneous tumor formation, in the form of a polyp, which forms a pedunculated growth. They usually develop in the neck, armpits, groin and knee (Curtis et al., 2007).
The appearance of molluscum pendulum becomes more frequent with aging and its narrow base easily recognizes it (Leung et al., 2017).
Molluscum pendulum is usually painless, but can be unsightly and cause discomfort. It can sometimes thrombose on its own or because of a trauma. In this case, it can present an inflammation and become painful, then necrotize and detach spontaneously (Sławińska et al., 2020).

Materiel and Methods
This is a 56-year-old patient, with no particular history, who presented in the consultation department with a small painless swelling on the postero-external face of the right knee that had been evolving since 1990. This swelling suddenly increased in volume during the month of June 2023 to reach the dimensions observed during the surgical resection, which took place on 01/07/2023. This rare case was observed at the Traumatological and Orthopedic Department 1 of the Military Hospital Mohammed V in Rabat.

Results
Given the rapid evolution of the tumor and its painless, hard and mobile character, the decision was taken to realize an excision of the mass, which was then sent for anatomopathological study. The histological study of the tumor confirmed the diagnosis of molluscum pendulum without signs of malignancy. The evolution of the patient was favorable after 45 days.

Discussion
Also called acrochordons, these are small pedunculated polyps, connected to the skin by a small narrow pedicle. They can take on the appearance of a small ball that hangs outward, hence their name molluscum pendulum.
These small growths of flesh have a soft consistency, with a smooth or wrinkled appearance, and flesh-pink or brown in color if hyperpigmented, then mistaken for moles.
Skin tags are most often found on the large folds of the body such as the neck, armpits and eyelids.
These are benign lesions, usually multiple and tend to increase with age.
We don't know exactly and their origin remains poorly understood. It would seem that a part of heredity and a disorder of the sebaceous glands would be factors favoring their appearance, which is justified by the presence of hyper pigmented skin tags on the face.
Specialists have also noticed that these molluscum pendulum were more common in people with diabetes, overweight, obesity, high blood pressure and in pregnant women during pregnancy.
Skin tags are totally benign and don't present any particular risks. However, they can become irritated if they are located on areas of friction (shirt collar, necklace, etc.) or bleed if you scratch them.
If so, or if they bother you aesthetically, then you can remove them.
But before that, make sure not to confuse them with a mole, a pre-cancerous lesion, warts or Molluscum Contagiosum, the latter being very contagious.
If in doubt, seek the advice of a health professional who will be able to confirm whether it is indeed skin tags.
What are the methods practiced by the dermatologist?
To remove skin tags, specialists can use different methods: 1) Cryotherapy: consists of applying liquid nitrogen, which freezes and destroys the Molluscum Pendulum by the cold.
2) Electrocoagulation of the Molluscum pedicle, which burns the area where the growth is positioned.
3) Cauterization: performed under local anesthesia, the skin tag is heated and burned with an electrocautery. A crust will then form and the ball of flesh will come off on its own after a few days.
4) Extraction or section: the dermatologist performs an excision using an electric scalpel or surgical scissors, under local anesthesia.

Conclusion
Skin tags are frequent, small, stalked, soft, fleshcolored or hyperpigmented lesions; the lesions are usually multiple, most often found in the neck, armpits and inguinal region. Molluscum pendulum may be associated with insulin resistance.Skin tags are usually asymptomatic, but can be irritated.
For our patient, despite the giant character of the tumor, the evolution was favorable after excision of the molluscum pendulum.