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The patient is a white woman aged 53 whose occupation for the past six years has been that of a social worker in a large county hospital in southern California. Her general health has been good. She has always lived in the United States, but in 1929 she went on a six months' tour of Europe, traveling through England, France, Belgium, Austria and Italy. While skirting the Mediterranean she visited Naples and made several short inland tours.
In September 1941 she noticed a small red papule on the middle of the left cheek about the level of the zygoma. Thinking that it was a mole, she did not bother to seek medical advice. About in February 1942 she noticed that the lesion was increasing in size and thickness and was covered with crusts; when these were accidentally pulled off there would be bleeding from an underlying ulcerated area.
When first