An Older Man With an Asymptomatic Depression on His Face

Authors:
Hannah J. Anderson, BA
Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania

Barbara B. Wilson, MD
Department of Dermatology, University of Virginia Health System, Charlottesville, Virginia

Citation:
Anderson HJ, Wilson BB. An older man with an asymptomatic depression on his face. Consultant. 2019;59(4):115-117.

A 75-year-old man with a history of multiple basal cell and squamous cell carcinomas of the face and scalp presented for a total body skin examination. The patient did not report any lesions of concern.

On physical examination, a hyperpigmented depression was noted 1 cm lateral to the right nasolabial fold (Figure). Palpation revealed a fixed nodule below the skin surface. No discharge was expressed from the lesion.

Figure. A hyperpigmented depression on the patient’s face with a palpable fixed nodule below the skin surface.

The patient had noticed the lesion 2 weeks prior when he had nicked it with a shaving razor. On further questioning, he revealed that he had had an abscess of the right maxillary canine tooth for the past 6 months. He had undergone a root canal procedure 4 days prior to presentation. He reported having had pain at the site of the tooth abscess but denied pain or discharge associated with the facial lesion.