Case 42:
Dr. Arun Kakde
Age: 43yrs
Sex-M
Address- Baurapur,Wardha
     E/O- Facial asymmetry due to swelling on left side of face extending superioinferiorly from infraorbital rim to the corner of mouth & anterio-posteriorly from lateral side of nose to the outer canthus of the left eye. Skin over the swelling is tense and reddish in colour .Surface smooth and shiny. Temperature of the skin over the swelling isnot raised , consistency firm , tender and non fluctuant.
No local cervical lymphadenopathy.
    I/O – Single oval, uleroproliferative lesion extending from distal of left 4 to maxillary tuberosity region about 4*2cm approx. in size and from buccal vestibule to the palatal marginal gingival. Smooth and shiny surface, soft in consistency, tender, ill defined margins, indurated base, smooth floor, ill defined borders, everted edged.
USG- multiple cervical lymohadenopathy
Basal cell adenocarcinoma
Click here for photomicrographs

---

 Case 43: Rameshwar Mundlee.
Age: 5 yrs
Sex: Male
Religion: Hindu
Occupation: Nil
Address: Wardha, Maharashtra

Chief complaint :- Parent of patient complain:
1. A large painful ulcer on the right side of face since 1 year
2. Brownish black spots on face since 3 months of age.
History of present illness:-
1. For Pigmentation- Patient was apparently alright till the age of 3 months, then his parents noticed brownish-black pigmentation on the face, which gradually increased in no. and spread over the entire body.
2. For Ulcer- Patient was apparently alright one year back then his parent noticed an ulcer which was of 1x1 cm, which increased to the present size of 7x7cm over a period of 1 year. Ulcer is associated with pain.
Family history: Patients younger brother who is 3 years old also shows multiple pigmented lesion of face and trunk.

Face is bilaterally asymmetrical due to ulcer on the right side of face. Small, numerous, discrete hyperpigmented blackish brown spots, round to oval in shape and are spread over the entire face

Inspection of the Ulcer:
Number: Single
Site: on the right side of face
Size: approx. 7X7Cm
Shape: round to oval
Color: same as the color of face. Darker in the center.
Surface: Rough
Border: Rolled margin surrounding the central depression giving umblicated appearance.
Palpation:-

Local temperature: not raised

Tenderness- present

Extent: SI: from the inner canthus of eye to 1 cm above the angle of the mouth AP: from the nasolabial fold to 1cm away from the zygomatic arch Ulcer covers the eye of the right side. The lower eyelid cannot be visualized and the upper eyelid is pushed upwards

Consistency: Soft to firm
Fluctuation: Not present
The swelling was not fixed to the underlying structure and was fixed to the overlying skin.
Small, numerous, discrete hyperpigmented blackish brown spots, round to oval in shape and are spread over the entire face.
Click here for photomicrographs

---

Note:  Please go to the "Interesting cases" page to see the members interpretations and our diagnosis for all the previous posted cases.