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Erythematous lesion with peripheral purpura on the face

An 87-year-old Japanese man presented with and 18-month history of asymptomatic swelling of the right side of his face. Physical examination showed a diffusely erythematous, indurated plaque with peripheral purpura on the right upper and lower eyelid and right cheek (Fig. 1), and the superficial lymph nodes were palpable in the right cervical and supraclavicular regions. The patient’s general condition was good, and the results of routine laboratory tests were all within the normal range, except for renal function. Fecal occult blood test was negative. Computed tomography scans of the chest and abdomen did not show any visceral tumours, but magnetic resonance imaging of the face demonstrated diffuse tumoural infiltration in the right malar and lower and upper eyelid region. A gastroendoscopic examination did not reveal any primary tumours. A skin biopsy was taken from the patient’s right cheek.