Photo Quiz

Changing Facial Lesion


FREE PREVIEW. AAFP members and paid subscribers: Log in to get free access. All others: Purchase online access.

FREE PREVIEW. Purchase online access to read the full version of this article.

Am Fam Physician. 2015 Nov 15;92(10):925-926.

A 70-year-old black woman presented with an enlarging lesion on the left side of her face. The lesion had been present as long as the patient could remember, likely since birth. It had slowly enlarged as she aged. Recently the lesion had begun to change in appearance, and the patient developed new associated pruritus, pain, and bleeding.

The physical examination revealed a 6-cm × 1-cm linear verrucous lesion extending from the anterior helix of the left ear down to the level of the ear lobe (Figure 1). The lesion was hyperpigmented and raised, and consisted of papules and nodules. There was an area of excoriation near the distal end of the lesion where one of the nodules had torn away from the base.

Figure 1.


Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Keratoacanthoma.

B. Nodular basal cell carcinoma.

C. Sebaceous nevus.

D. Squamous cell carcinoma.

Address correspondence to Gregg Mitchell, MD, at Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


show all references

1. Nevus sebaceous. In: Habif TP. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 4th ed. Edinburgh, Scotland: Mosby; 2004....

2. Moody MN, Landau JM, Goldberg LH. Nevus sebaceous revisited. Pediatr Dermatol. 2012;29(1):15–23.

3. Wright TS. Nevus sebaceous and nevus sebaceous syndrome. UpToDate. January 30, 2014. (subscription required). Accessed April 22, 2015.

4. Brewer JD. Keratoacanthoma: epidemiology, risk factors, and diagnosis. UpToDate. February 4, 2015. (subscription required). Accessed April 22, 2015.

5. Wu P. Epidemiology and clinical features of basal cell carcinoma. UpToDate. May 4, 2015. (subscription required). Accessed August 30, 2015.

6. Lim J, Asgari M. Clinical features and diagnosis of cutaneous squamous cell carcinoma (SCC). UpToDate. May 21, 2014. (subscription required). Accessed April 22, 2015.

This series is coordinated by John E. Delzell, Jr., MD, MSPH, Assistant Medical Editor.

A collection of Photo Quiz published in AFP is available at

Previously published Photo Quizzes are now featured in a mobile app. Get more information at

The editors of AFP welcome submissions for Photo Quiz. Guidelines for preparing and submitting a Photo Quiz manuscript can be found in the Authors' Guide at To be considered for publication, submissions must meet these guidelines. E-mail submissions to


Copyright © 2015 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz

More in AFP

Editor's Collections

Related Content

More in Pubmed


Dec 1, 2016

Access the latest issue of American Family Physician

Read the Issue

Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article