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Joseph L. Cvancara, MD; J. Michael Wentzell, MD
Advanced Dermatology and Skin Surgery, Spokane, Wash (Dr Cvancara), and Deaconess Billings Clinic, Billings, Mont (Dr Wentzell)

Arch Dermatol. 2005;141:897-902.

	Since this article does not have an abstract, we have provided the first 144 words of the full text and any section headings.

REPORT OF A CASE

A 75-year-old man presented with a 3-year history of an intermittent ulcer on his left ala. His medical history was significant for chronic obstructive pulmonary disease. He also had a complicated ophthalmic history, which included left-sided tic douloureux with intractable pain that had been treated by trigeminal ganglionectomy 12 years earlier. He subsequently developed a left-sided neurotrophic cornea and Bell palsy. He wears protective glasses to prevent corneal trauma.

An asymmetrical nose with left alar lobule atrophy (Figure 1 and Figure 2) was observed on physical examination of the patient’s skin. A small ulcer with crust was at the base of the alar rim. A Tzanck preparation and a 6-mm shave biopsy of the cutaneous edge and ulcer were performed (Figure 3).

Figure appears in full text version. Figure 1.

Figure appears in full text version. Figure 2.

Figure appears in full text version. Figure 3.

What is your diagnosis?

SECTION EDITOR: MICHAEL E. MING, MD

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Arch Dermatol. 2005;141(7):897-902.
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