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Clinical Challenge
September 2016

Left Temple Ulceration

Author Affiliations
  • 1Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas
  • 2Department of Pathology, MD Anderson Cancer Center, Houston, Texas
JAMA Otolaryngol Head Neck Surg. 2016;142(9):909-910. doi:10.1001/jamaoto.2016.0026

A man in his 70s presented with a 3- to 4-month history of a small cutaneous lesion on his left temple. The lesion was growing in size and had begun to drain. Prior to the visit, he had been evaluated in emergency care for the same complaint and was given a prescription of oral antibiotics; however, the lesion persisted. Afterward he was referred to a local dermatologist, who performed a biopsy of the lesion. His medical history was significant for emphysema but no previous skin cancers or surgery. On physical examination, the patient had a 2.5 × 2-cm, singular, umbilicated, ulcerated papular lesion of the left temple with overlying crusts and surrounding erythema and induration (Figure, A). Computed tomography with contrast of the soft tissue revealed an abnormal mass in the site of the left temporal scalp lesion. The mass appeared homogenous and was not particularly enhanced by contrast (Figure, B). There was no accompanying surrounding lymphadenopathy. A preoperative biopsy and low-power histological analysis revealed an epidermal proliferative process; vertically oriented anastomosing strands of basaloid epithelium were seen arising from multiple points along the epidermis (Figure, C). In this case, there was concurrent well-differentiated carcinoma (Figure, C). Ductal differentiation was observed on high power, and the mass had an intervening fibrovascular stroma (Figure, D).

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