Wednesday, February 05, 2014
What is your diagnosis?
A middle aged woman presented with an asymptomatic large brownish red plaque on the right side of the face, and the right ear lobe which developed from a small papule over a period of ten years. Physical examination revealed a large well demarcated brownish red plaque involving the right side of the face, angle of the jaw, the submadibular area, and the pinna of the right ear. (Figure 1) On palpation, the plaque was smooth surfaced, non-tender and soft in consistency. There was no family history of similar dermatosis. The patient had been prescribed multiple drugs including oral antibiotic and topical steroids for the treatment of the lesion by a few GPs but the lesion did not respond and kept on slowly progressing and extending to involve the adjacent area over time. Histopathologic examination of a biopsy specimen revealed multiple granulomas surrounded by chronic inflammatory cells and central necrosis. Considering the clinical and histopathologic findings, what is your diagnosis?