Ulcerated Plaque of the Face

REPORT OF A CASE A 72-year-old man was referred with an erythematous and ulcerated plaque on his right cheek. The lesion was asymptomatic and had slowly enlarged since its appearance 7 years ago. Two months before consultation, an ulceration developed. On clinical examination there was an erythematous, indurated, well-delineated plaque on his right cheek (6 cm). Within the lesion, several superficial telangiectasias, hyperkeratotic plugs, and necrotic ulcers were observed ( Figure 1 ). No other areas of the cutaneous surface were affected. The patient was healthy and routine laboratory test results were normal. A biopsy specimen was taken. Histologic sections are shown in Figure 2 and Figure 3 . What is your diagnosis? Figure 1. Figure 2. Figure 3. DIAGNOSIS: Atypical necrobiosis lipoidica. HISTOPATHOLOGIC FINDINGS At low power, large areas of altered collagen were seen throughout the dermis but especially in the lower portions (Figure 2). The collagen bundles in these areas appeared