A nonimmunosuppressed 67-year-old man was referred to our clinic for treatment of facial lesions previously given the microscopic diagnosis of keratoacanthoma. Eight months earlier, the patient noticed what he thought was a cold sore on his upper lip. The lesion was excised after it failed to resolve. Two months later, rapidly enlarging, massive verrucous plaques involving the upper lip, nasal tip, and right ala developed. Despite treatment with topical fluorouracil and isotretinoin (40 mg/d), the lesions continued to enlarge (Figure 1). An incisional biopsy specimen was obtained from the lip lesion (Figure 2). Purulent debris was stained with Gomori methenamine-silver (Figure 3).
Woofter MJ, Cripps DJ, Warner TF. Verrucous Plaques on the Face. Arch Dermatol. 2000;136(4):547-552. doi: