REPORT OF A CASE
A 72-year-old woman presented with a 2-year history of facial plaques. The lesions began on her upper lip and gradually spread to involve most of her face. The lesions were mildly pruritic. Prior treatment with topical steroids yielded no improvement. The patient's history was significant for hypertension and diabetes mellitus.On physical examination over the forehead, cheeks, and upper lip were confluent, violaceous indurated nod- ules and plaques resulting in leoninelike facies (Figure 1). A biopsy specimen from the upper lip is shown below (Figure 2 and Figure 3). A 2-cm firm, nontender, mobile submandibular lymph node was palpated. A subsequent biopsy specimen of this node revealed reactive lymphoid hyperplasia. There was no hepatosplenomegaly.Laboratory evaluation, including complete blood cell count with differential, electrolytes, liver function studies, and urinalysis, all were within normal limits. Computed tomographic scan of the chest and abdomen was unremarkable.What is