An 86-year-old white woman presented with an erythematous lesion on her nose in October 2001. She was treated with topical metronidazole cream for a presumed diagnosis of rosacea. Despite several months of therapy, the lesion continued to enlarge, and a biopsy specimen was obtained in April 2002. The patient was otherwise in good health.
On examination, a slightly indurated, well-demarcated erythematous to violaceous nodule was seen extending from the midnasal bridge to the nasal tip, creating a bulbous deformity of the nasal tip (Figure 1). There was no involvement of the anterior nares or nasal septum. No other lesions were seen on the face or scalp. Also, there was no evidence of cervical, axillary, or inguinal lymphadenopathy or hepatosplenomegaly. A biopsy specimen of the lesion was reviewed at our institution (Figure 2).