PATHOLOGIC QUIZ CASE
Marion V. Filippone, MD, Robert E. Fechner, MD, Houston
This 59-year-old rancher-farmer sought treatment four years after surgical excision of a squamous cell carcinoma of the left nasolabial fold. He remained asymptomatic until about six months ago when he developed erythema and pain over the area of the rotation flap. He was treated with antibiotics with only minimal improvement, and a subsequent incisional biopsy of this area was reported as inflammatory tissue reaction. The patient remained symptomatic with progressive nasal obstruction on the left side, increased tenderness, and erythema over the above-mentioned area (Fig 1), and the development of numbness over the left upper lip which extended into the cheek. A punch biopsy of this indurated area (Fig 2) was performed by a dermatologist and the patient was referred to the otolaryngologist for further evaluation and definitive treatment. On examination there was an erythematous indurated area