Physical examination revealed honey-colored exudate over the lesion, with extension to the right side under the chin and a right submandibular mass concerning for pathologic cervical lymphadenopathy. Erythema and peripheral crusting with central ulceration at the area of the left jawline and the lower lip (Figure 1) were present. There was a subdermal plaque at the level of the left thyroid cartilage with medial soft tissue fullness and a firm, mobile plaque with overlying erythema and minimal ulceration. There was significant concern for malignancy due to the fungating appearance with subcutaneous extension. Deep biopsies of the left facial lesions and a fine needle aspiration of the right submandibular mass were performed.
—Tristan Klosterman, MD, Adam Bied, MD, Ramsay Farah, MD, and Amar Suryadevara, MD, Upstate Medical University, Syracuse, N.Y.
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