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July 1996

A Nodule on the Lip

Author Affiliations

University of Texas Medical Branch, Galveston

Arch Dermatol. 1996;132(7):825-826. doi:10.1001/archderm.1996.03890310111020

REPORT OF A CASE  A 25-year-old woman 150 presented with a 2-month history of an enlarging lesion on the left side of her upper lip. The lesion was moderately tender. She also reported developing a nodule on the left side of her neck and influenzalike symptoms several days earlier.Examination showed a 1.5-cm-diameter erythematous crusted nodule near the vermillion border on the left side of her upper lip (Figure 1) and a mildly tender, mobile 2-cm-diameter enlarged left submandibular lymph node. The findings of the rest of the examination were normal.A skin biopsy was performed. Microscopic features of the specimen are shown in Figure 2.

DIAGNOSIS:  Nodular secondary syphilis.

HISTOPATHOLOGIC FINDINGS AND CLINICAL COURSE  The biopsy specimen showed papillomatous and acanthosis of the epidermis and a dense lymphoplasmocytic infiltrate filling up the dermis. A Steiner stain for spirochettes was done, and it showed multiple organisms, particularly in the areas of the epidermis involved by neutrophils (Figure 3). Additional history from the patient

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