# A graphite foreign body granuloma that caused palatal perforation. Case report and literature review

## TL;DR

A 62-year-old woman had a graphite foreign body granuloma that caused a hole in her palate, initially mistaken for a melanoma.

## Contribution

The paper reports a rare case of a graphite-induced granuloma causing palatal perforation and highlights the diagnostic importance of excising graphite tattoos.

## Key findings

- A graphite foreign body granuloma led to oroantral communication and palatal perforation.
- Microscopic examination confirmed the presence of a graphite granuloma, not malignant melanoma.
- Graphite tattoos can cause tissue destruction and should be excised for diagnostic and therapeutic reasons.

## Abstract

We present an unusual case of a graphite foreign body granuloma causing palatal perforation.

A 62-year-old female presented with a macule on the hard palate clinically consistent with a blue nevus. On biopsy a black nodular mass was excised, establishing oroantral communication that was verified by a computed tomography scan. A diagnosis of malignant melanoma was strongly suspected, but microscopic examination showed a graphite foreign body granuloma. It was suggested that the graphite was implanted in a thin area of the palatal bone causing perforation.

Graphite tattoos should be excised, both for diagnostics purposes and the possibility of causing tissue destruction by generating a foreign body granuloma reaction.

Key words:Pencil core granuloma, graphite, foreign body, palate, case report.