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Clinical Problem Solving
April 2014

A Growing Lesion on the Cheek

Author Affiliations
  • 1Medical University of South Carolina, Charleston
JAMA Otolaryngol Head Neck Surg. 2014;140(4):383-384. doi:10.1001/jamaoto.2013.6770

A woman in her 60s with a Fitzgerald skin type II presented to the clinic with a 4- to 5-month history of a growing lesion on her right cheek. The physical examination demonstrated a 3.5-cm indurated, semifixed, multifocally ulcerating mass surrounded by an erythematous rim overlying the zygoma with a subdermal and subcutaneous extension measuring 4.2 × 4.5 cm. It was nonpigmented except for a small patch along the inferior margin. The right facial and trigeminal nerve branches were intact. There was no lymphadenopathy. Two punch biopsy specimens were obtained and later demonstrated a malignant neoplasm. The patient underwent wide local excision of the mass with a right parotidectomy and a right lymph node dissection of levels 2A, 2B, 3, and 4.

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