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July 2010

An Exophytic Nasal Nodule—Quiz Case

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Arch Dermatol. 2010;146(7):789-794. doi:10.1001/archdermatol.2010.150-a

A 40-year-old black man was seen with an enlarging, tender, exophytic nasal nodule and multiple small, white, cystic lesions over the nose along with small, crusted lesions on the temple. The lesions were preceded by an influenzalike illness that had resolved spontaneously 4 weeks earlier. The patient had no other medical problems. He had been living in Arizona for 17 years, the last 4 years in metropolitan Phoenix. He denied any travel outside the continental United States. On physical examination, the patient had a 1.5 × 1.0-cm exophytic, centrally crusted, and eroded nodule on the right ala. The lesion extended to the lateral dorsal portion of the nose superiorly and along the alar rim with clinically significant erythema inferiorly. In addition, there were multiple small, white, cystic lesions on the dorsum of the nose and several crusted papules on the right temple. There was no cervical lymphadenopathy. An incisional biopsy was performed (Figures 1, 2, and 3).

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