An incisional skin biopsy specimen from the glabella showed a diffuse granulomatous infiltrate within the dermis and subcutis (Figure 3 and Figure 4). The infiltrate was composed of lymphocytes, plasma cells, histiocytes, and multinucleated giant cells with vacuolated spaces, giving the specimen a Swiss cheese–like appearance. Scattered asteroid bodies were noted. Energy-dispersive x-ray probe microanalysis demonstrated the presence of silicon.