Hyper-pigmented plaque over right side of the nose. 

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Context 1

... 62year old female came with the complaint of asymptomatic darkly pigmented lesion over the right side of the nose since one year, initially small in size, measuring about 0.2x0.2cms, gradually progressed to the present size of 1x1cms. Patient gives history of spontaneous bleeding from the lesion. No history of significant loss of weight or appetite. On examination, a solitary, oval, well-defined, hyperpigmented plaque, measuring about IxI cm with irregular margins, surface showing area of ulceration, present over the right lateral wall of the nose, above the right ala (Fig. 1). No regional lymphadenopathy was noted. A differential diagnosis of pigmented basal cell carcinoma, keratoacanthoma, malignant melanoma was considered. A wide local excision with full thickness graft was planned (Fig. 2). Under aseptic precautions, after local infiltration of the lesion, an elliptical incision was placed with 0.5cm margin all around the lesion and the tumor was removed in toto and sent for histo-pathological examination. A same sized full thickness graft was harvested from the right post auricular area and placed over the recipient site and sutured with no tension (Fig. 3). The margins of the biopsy specimen were marked and sent for histo-pathological examination which revealed that the tumor was arising near the basal layer consisting of large and small nests of basaloid cells (tumor cells) with peripheral palisading. The stroma showed the presence of melanophages and melanin interspersed amongst tumor cells along with lymphoplasmacytic infiltrate is seen. The tumor is seen extending from entire dermis upto the muscle. The lateral and deeper resected margins were free of tumor (Fig. ...

Context 2

... 1x1cms. Patient gives history of spontaneous bleeding from the lesion. No history of significant loss of weight or appetite. On examination, a solitary, oval, well-defined, hyperpigmented plaque, measuring about IxI cm with irregular margins, surface showing area of ulceration, present over the right lateral wall of the nose, above the right ala (Fig. 1). No regional lymphadenopathy was noted. A differential diagnosis of pigmented basal cell carcinoma, keratoacanthoma, malignant melanoma was considered. A wide local excision with full thickness graft was planned (Fig. 2). Under aseptic precautions, after local infiltration of the lesion, an elliptical incision was placed with 0.5cm ...