Midline lethal granuloma remains as much a mystery as when it was first described before the turn of the century.1 A rare condition which usually starts in the nose, it spreads centrifugally, involving both superficial and deep nasal tissues. There is first local thickening and gradual interference with tissue nourishment and drainage. Ulceration may occur early or late. Strangely, there is no leukocytosis or toxemia. Initially, the patient usually feels well except that he is concerned with his appearance. Not until the downward swing does the patient complain of fatigue. There is no regional lymphadenopathy so characteristic of canceration nor is there the lymphatic spread to satellite lesions seen in fungus infections. The process may be slow or rapid. Disfiguring lesions are markedly manifested during the terminal phase of the disease. The pathologic picture usually consists of a chronic fibrous, nonspecific inflammatory granulation tissue infiltrated by pleomorphic inflammatory cells.