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Verrucous Plaques on the Face
Melinda J. Woofter, MD;
Derek J. Cripps, MD;
Thomas F. Warner, MD
University of Wisconsin Medical School, Madison
Arch Dermatol. 2000;136:547-552.
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REPORT OF A CASE
A nonimmunosuppressed 67-year-old man was referred to our clinic for treatment of facial lesions previously given the microscopic diagnosis of keratoacanthoma. Eight months earlier, the patient noticed what he thought was a cold sore on his upper lip. The lesion was excised after it failed to resolve. Two months later, rapidly enlarging, massive verrucous plaques involving the upper lip, nasal tip, and right ala developed. Despite treatment with topical fluorouracil and isotretinoin (40 mg/d), the lesions continued to enlarge (Figure 1). An incisional biopsy specimen was obtained from the lip lesion (Figure 2). Purulent debris was stained with Gomori methenamine-silver (Figure 3).
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Figure 1.
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Figure 2.
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Figure 3.
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What is your diagnosis?
Diagnosis: North American blastomycosis.
The biopsy specimen showed marked pseudoepitheliomatous hyperplasia with intraepidermal microabscess formation. The dermis showed a dense infiltrate of neutrophils, giant . . . [Full Text of this Article]
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