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A 41\u2010year\u2010old female presented with a subcutaneous nodule on the right forearm clinically suggestive of cyst, foreign body, or lipoma. Excisional biopsy revealed subcutis with a sarcoid\u2010like granulomatous reaction in a background of fibrosis, containing abundant semitransparent, exquisitely geometric particles, mildly refringent under polarized light, highlighted by phase contrast microscopy; special stains were negative for microorganisms. Definitive characterization of the peculiar fragments was accomplished by confocal laser microscopy, scanning electron microscopy, and energy dispersive X\u2010ray spectroscopy, revealing them as diatom frustules made of silicon dioxide (SiO<jats:sub>2<\/jats:sub>) or silica. Diatoms are unicellular algae, their skeletons (frustules) made of silica have collected on the bottom of rivers, lakes, and oceans for thousands or millions of years and form what we know as diatomite or diatomaceous earth, which is widely used in different industries and easily available in the market. The mechanism whereby diatom frustules gained access to the patient's subcutis is enigmatic.<\/jats:p>","DOI":"10.1111\/cup.13991","type":"journal-article","created":{"date-parts":[[2021,2,18]],"date-time":"2021-02-18T16:27:35Z","timestamp":1613665655000},"page":"795-801","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["It's elemental! 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