A Rapidly Growing Facial Mass: Challenge

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A homeless immunocompetent 45-year-old woman with no significant medical history presented with 1-year history of a facial mass. The mass started as a small red bump initially believed to be a spider bite. After months of relative stability in size, it had rapidly grown over the previous 6 weeks. The mass was tender and bled spontaneously. Increasing left-sided weakness, left-sided visual changes, and weight loss prompted the patient to seek medical attention. Physical examination revealed an erythematous to pink, lobulated, firm mass over the left temple and malar cheek (Fig. 1). There were numerous areas of erosion with frank hemorrhage and depressions plugged with caseous white material. Lymph node examination was within normal limits. Magnetic resonance imaging revealed an exophytic heterogeneously enhancing mass of the soft tissue over the temple without involvement of the orbit. Multiple scout biopsies were obtained.
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