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Man with a red bump on his nose.

70 year old man presents with an irritated, red papule on the left side of his nose as shown in the photograph. He has a history of a treated basal cell carcinoma on his right lower eyelid (6 years ago) and a treated superficial squamous cell carcinoma on his left forearm (3 years ago), and multiple actinic keratosis.

His bridge partner told him that he had a very similar lesion on his nose and it turned out to be skin cancer. He reports “This lesion looks a lot like the basal cell carcinoma I had under my eye, but it does not bleed, like that one did.”

He has a past medical history of treated hypertension, gout (left great toe, no flare ups in 2 years), and arthritis in his left knee. He wears glasses.

What’s your diagnosis?

Case of the Month

Diagnosis:

Acanthoma fissuratum

Discussion
Acanthoma fissuratum (also known as "Granuloma fissuratum and "Spectacle frame acanthoma" is a skin condition characterized by local thickening of the skin in response to low-grade, chronic pressure/rubbing caused by eyeglasses. It commonly presents as a red, irritated nodule that can mimmic a basal cell carcinoma. It can also occur on top/behind the ear where the eyeglass frames rest, as well as inside the mouth as a response to poor fitting dentures. Pathology is similar to lichen simplex chronicus.

Treatment:
Emollient and anti-inflammatory creams as needed to control symptoms of irritation/discomfort. But the real solution is to remove the offending agent by having frames re-fitted or changed.

 

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