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Clinical Problem Solving: Pathology
April 18, 2011

Pathology Quiz Case 1: Diagnosis

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Copyright 2011 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2011

Arch Otolaryngol Head Neck Surg. 2011;137(4):413. doi:10.1001/archoto.2011.48-b

Granuloma faciale is a rare, benign, chronic dermatologic condition that is traditionally characterized by a single nodule or a few cutaneous nodules over the face.1It was first described in 1950 as a distinct entity because of its eosinophilic infiltrate.2It is most commonly found in whites, with a male predilection and a median age at diagnosis of 45 years. While the most common site of manifestation is the face, extrafacial GF has rarely been reported.3The pathogenesis is unknown, although it has been postulated that GF is a form of vasculitis that is mediated by a localized Arthus-like hypersensitivity reaction.4More recently, clonal T-cell production of interleukin 5 has been cited as an explanation for the eosinophilic inflammation seen in GF.5Growth of GF plaques is slow, insidious, and usually asymptomatic. Lesions occasionally cause mild pruritus or pain, while larger lesions may cause a localized mass effect. Grossly, the lesions appear as red to reddish brown, well-circumscribed, elevated plaques that vary from a few millimeters to several centimeters in diameter. Spontaneous involution of GF lesions is rare. Granuloma faciale does not have any malignant potential, although there is 1 reported case of coincident basal cell carcinoma and GF.6

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