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An 83-year-old male renal transplant recipient who had undergone excision of an in situ squamous cell carcinoma 3 months previously presented with nonhealing ulcerating nodules near his surgical site on the left preauricular cheek (Figure 1). He had no history of travel outside of northern Vermont. Findings from a physical examination revealed 1.5- to 2-cm, deeply seated, fluctuant nodules with ulceration. He had no lymphadenopathy. Medications included tacrolimus and prednisone. Results from a complete blood cell count and a chest radiograph were within reference range. A biopsy specimen obtained from a nonnecrotic area was sent for histologic examination (Figure 2 and Figure 3).
Hartford OA, Pothiawala GA, Goldman GD. Ulcerated Facial Nodules in a Renal Transplant Recipient—Quiz Case. Arch Dermatol. 2010;146(1):81–86. doi:10.1001/archdermatol.2009.333-a
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