What’s the diagnosis? >>> A 65-year-old man presented with a reoccurring 2×2-cm violaceous nodule on the superior helical rim of the left ear. Three years prior, he presented with a 6-mm papule of the left superior helix. Punch biopsy at the time found a spindle cell tumor with negative immunostaining for S-100, CD34, and MNF-116 (antipan cytokeratin antibody). He was subsequently referred to #Mohs surgery for complete excision. .
A year later, he presented with a new 5-mm nodule at the same location on the ear. Punch biopsy at the time revealed an extensive residual dermal neoplasm composed of cytologically atypical and pleomorphic spindle cells. Immunostaining for S-100, CD34, and MNF-116 were negative, thus, favoring a diagnosis of recurrent AFX. Additional immunostaining was not done at that time, and the patient underwent radical resection of the left ear with 1-cm margins.
The patient denied a history of radiation or trauma to the head and neck region. He denied past chemical exposure to arsenic, thorium dioxide, or vinyl chloride.
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