Hyperpigmented Plaque on a Farmer’s Nose: A Quiz

Abstract

A 66-year-old man presented with a 1-year history of asymptomatic hyperpigmented plaque on his apex nasi. The lesion initially appeared as erythematous macules, and several open, black comedones gradually developed. The patient was a farmer and had worked outdoors for more than 40 years without sun protection, which resulted in substantial sun exposure. He also had smoked >10 cigarettes daily for more than 40 years. On physical examination, a 1.5×2-cm hyperpigmented plaque was located on the apex nasi; it showed symmetrical distribution of multiple open, black comedones ( Fig. 1A). Wrinkles and furrows were present on the patient's forehead. The remainder of his physical examination was unremarkable. Laboratory tests were negative, including complete blood count, antinuclear antibodies, and dsDNA antibodies. A lesional punch biopsy showed epidermal atrophy, solar elastosis, and multiple dilated follicular infundibula filled with laminated keratinous material (Fig. 1B). Focal elastosis and degeneration of elastic fibres were observed in the dermis (Fig. 1C). Fig. 1. (A) Clinical image. A hyperpigmented plaque with multiple open, black comedones on the apex nasi. (B) Histopathological image. A lesional punch biopsy showed epidermal atrophy, solar elastosis, and multiple dilated follicular infundibula filled with laminated keratinous material (haematoxylineosin staining ×40). (C) Special stain image. Focal elastosis and degeneration of elastic fibres were observed in the dermis (elastic fibre staining ×40).