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April 1991

Purple Facial Nodule

Author Affiliations

Veterans Administration Medical Center and University of California at San Francisco

Arch Dermatol. 1991;127(4):571-576. doi:10.1001/archderm.1991.04510010169021

REPORT OF A CASE  A 67-year-old white man presented with a nodular growth below his left eye (Fig 1). The nodule grew rapidly over a 3-week period. Prior trauma to the area or bleeding from the nodule was not reported. The patient, who claimed to have been discharged recently from the orthopedic service, denied other medical problems.Examination revealed a 2.5 × 1.2-cm smooth, erythematous, firm, pedunculated, lesion that was neither compressible nor pulsatile (Fig 1). The patient also had a similar, but smaller, lesion (3 mm in diameter) directly medial to the larger nodule. An excisional biopsy was performed. Representative histologic sections are shown in Figs 2 and 3.What is your diagnosis?

DIAGNOSIS:  Metastatic renal cell carcinoma.

DISCUSSION  Despite its overall low incidence among all malignancies (1% to 2.8%), renal cell carcinoma has been reported to comprise 7% of

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