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August 2006

Dairy Farmer With a Rapidly Enlarging Lip Lesion—Quiz Case

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Arch Dermatol. 2006;142(8):1059-1064. doi:10.1001/archderm.142.8.1059-b

A 59-year-old dairy farmer presented with a 2-week history of a nonpainful, rapidly enlarging mass on his lip. The lesion, which had begun as a small erythematous area on the right side of the upper lip, had evolved into a nodule and continued to grow. A primary care physician initially treated the patient with amoxicillin–clavulanate potassium, but there was no improvement.

Physical examination revealed a large bulbous mass occupying the entire right side of the upper lip, extending from the mucocutaneous margin into the right nareof the nose (Figure 1). Minimal cervical lymphadenopathy was observed in the midline and right side of the neck. A biopsy specimen was sent for histopathologic examination (Figure 2 and Figure 3).