A 71-YEAR-OLD MALE INMATE presented to the otolaryngology service with a 9-month history of an enlarging, painful lesion involving the right side of the upper lip and nose. Initially, the patient noted a "pimple" that did not respond to topical and oral antibacterial therapy. His medical history was remarkable for the removal of a skin cancer on his lower lip 14 years ago at an outside facility. He denied systemic complaints, except for an episode of mild pneumonia 1 year before presentation that had resolved with oral antibiotic therapy. He denied sick contacts, travel, or occupational exposures. He had a 15 pack-year smoking history.