Pathologic Quiz Case 1
Roger J. Levin, MD, John S. Rubin, MD, Bronx, NYA 67-year-old woman visiting from Puerto Rico presented with a 6-month history of multiple raised, ulcerated, scaling lesions of the forehead and face (Fig 1). The lesions were superficial, nontender, firm, and mobile. The patient was described by her daughter as being a chronic facial scratcher who continuously picked at her lesions. She denied any constitutional signs or symptoms. Her medical history was otherwise noncontributory. The findings of physical examination, routine laboratory studies, chest roentgenography, and electrocardiography were essentially unremarkable.Multiple punch biopsies of the patient's forehead and nasal lesions revealed normal skin and appendages with nonspecific inflammation and ulceration. She was given a provisional diagnosis of "factitious ulcers" secondary to chronic, self-induced skin irritation. An excisional biopsy of a forehead lesion was then performed, which on frozen section also demonstrated chronic inflammation and ulceration of
RESIDENT'S PAGE: PATHOLOGY. Arch Otolaryngol Head Neck Surg. 1993;119(8):904–906. doi:10.1001/archotol.1993.01880200110016
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