Molluscum contagiosum is a common, benign skin condition caused by a poxvirus.  Infection is spread via direct contact, contaminated fomites (eg, towels), or autoinoculation.  Molluscum is most commonly seen in children but also presents in sexually active or immunocompromised adults.  The classic presentation is firm, round, pink or flesh-colored papules with central umbilication.  The lesions are often shiny, may be itchy, and occasionally become inflamed.

In children, affected areas typically include the trunk, intertriginous areas (eg, axillae), and face (including the periocular region).  Lesions in atypical regions, even the genital area, in children are typically due to autoinoculation and usually not sexual abuse (Choice B).  In contrast, in most adults, lesions are in and around the genital area due to sexual contact.

The diagnosis of molluscum contagiosum is clinical, and symptoms typically self-resolve within 6-12 months.  Management in healthy children is reassurance and observation.  Treatment with cryotherapy, curettage, or topical therapy (eg, cantharidin) is often used in adults but can be painful and lead to scarring.  Therefore, in children, these methods are typically reserved for those with significant discomfort or complications (eg, superinfection, bleeding).

(Choice A)  Histologic examination of molluscum lesions classically shows cytoplasmic inclusion bodies.  However, the diagnosis is clinical in classic cases, such as this one, and biopsy is reserved for atypical presentations with an uncertain diagnosis.

(Choice C)  Intralesional steroid injection can treat keloids, which are excessive tissue growths that develop at the site of a prior injury.  This patient has no history of localized trauma, and keloids do not have central umbilication.

(Choice E)  Neurofibromatosis type 1 (NF1) causes cutaneous neurofibromas, which develop in adolescence as soft, compressible, flesh-colored lesions; genetic testing for NF1 gene mutation can confirm the diagnosis.  This patient's age and the presence of firm lesions with a central indentation make this diagnosis unlikely.  In addition, he has no additional features of NF1, such as café au lait macules or axillary/inguinal freckling.

Educational objective:
Molluscum contagiosum, a benign skin infection common in children, presents with flesh-colored papules with central umbilication.  Lesions resolve within 6-12 months.  Management is typically reassurance and observation.