Solitary Facial Plaque of Long Duration

REPORT OF A CASE A 52-year-old white man presented with a 2-cm, slightly hypopigmented, firm annular lesion with a slightly elevated border ( Figure 1 and Figure 2 ). The lesion had been present on the right cheek for more than 20 years and had gradually enlarged. In addition, an 8-mm tan-pink nodule that had grown over 6 months was present on the dorsum of the right second toe. Two punch biopsy specimens of the lesion on the cheek were taken to assure a representative sample. A specimen was also taken from the nodule on the toe. A biopsy specimen of the facial lesion is shown ( Figure 3 and Figure 4 ). What is your diagnosis? DIAGNOSIS: Desmoplastic trichoepithelioma. HISTOPATHOLOGIC FINDINGS AND CLINICAL COURSE The two biopsy specimens of the cheek showed identical features. Cords of basaloid cells and scattered small keratinous cysts were embedded