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Asymptomatic facial nodules

An 86-year-old man presented with a 5-day history of a large, asymptomatic, crusted nodule on his forehead and the more recent onset of a smaller nodule on his left cheek. He denied any new medications, recent travel abroad or insect bites. He was otherwise systemically well. On physical examination, a centrally crusted nodule 40 9 40 mm in size with surrounding erythema and swelling, was seen on the patient’s forehead, associated with swelling over the bridge of the nose and periorbital oedema. On the left cheek was a further smaller area of crusting (Fig. 1). Results of routine blood tests, levels of C-reactive protein, glucose, and immunoglobulin, and a virology screen [including human immunodeficiency (HIV) titres] were normal, apart from mild lymphopenia and eosinophilia.