Cutaneous lesions of the nose

Abstract

Skin diseases on the nose are seen in a variety of medical disciplines. Dermatologists, otorhinolaryngologists, general practitioners and general plastic and dermatologic surgeons are regularly consulted regarding cutaneous lesions on the nose. This article is the second part of a review series dealing with cutaneous lesions on the head and face, which are frequently seen in daily practice by a dermatologic surgeon. In this review, we focus on those skin diseases on the nose where surgery or laser therapy is considered a possible treatment option or that can be surgically evaluated.

Figure 1

Comedo. Multiple closed comedos at the nasolabial fold and the alar of the nose.

Figure 2

Fibrous papule of the nose. Small skin-colored papule with smooth surface.

Figure 3

Adenoma sebaceum. Multiple wart-like, waxy lumps consisting of angiomatous and fibrous tissue associated with tuberous sclerosis.

Figure 4

Eccrine hydrocystoma. Multiple small papules. Some are skin-colored; the larger papules are dark ("hydrocystome noire").

Figure 5

Rhinophyma. Large exophytic, pink, lobulated mass over the nose with superficial vascular dilation. The lesion is spreading to the cheeks; however, it can also be limited to the nose.

Figure 6

Infantile hemangioma. Well-circumscribed red, violet, exophytic vascular tumor on the nose of a one-year-old child.

Figure 7

Nevus araneus (spider nevus). In the center of the red lesion a small (1 mm) red papule is visible, surrounded by several distinct radiating vessels. Pressure on the lesion causes it to disappear. Blanching is replaced by rapid refill from the central arteriole when pressure is released.

Figure 8

Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome). Flat, star-shaped skin lesions 1-3 mm in diameter on the entire face. Some non-pulsating telangiectasias appear similar to araneus nevi. A papule the size of a match head is visible at the alar.

Figure 9

Rosacea. Erythema and telangiectasia are seen over the cheeks, nasolabial area and nose. Inflammatory papules and pustules can be observed over the nose. The absence of comedos is a helpful tool to distinguish rosacea from acne.

Figure 10

Facial eosinophilic granuloma. Red-brown nodule on the nose. Clearly visible follicular structures ("peau d'orange").

Figure 11

Cutaneous lesions of sarcoidosis (lupus pernio). Red-to-purple indurated plaques and nodules affecting the nose and cheeks.

Figure 12

Congenital melanocytic nevus. Brown papule on the nose, which developed shortly after birth. The brownish exophytic lesion is well circumscribed.

Figure 13

Micrographic surgery according to the Tuebingen cake technique. The base and the margin of the tumor are assessed separately. (modified according to Prof. Breuninger (120))

Figure 14

Mohs surgery allowing the complete circumferential peripheral and deep margin assessment, using frozen section histology. (modified according to Prof. Breuninger (120))

Figure 15

BCC Nodular type. Red, waxy nodule on the tip of the nose. Visible telangiectasias over the surface.

Figure 16

Pigmented BCC. Dark nodule (resulting from melanin deposition) at the alar of the nose. Small ulceration at the center.

Figure 17

Scar-like morphea-like BCC. Sclerotic, partially reddish plaque. Crusting in the center.

Figure 18

Kaposi's sarcoma. Characteristic violaceous plaques on the alar and tip of the nose in an HIV-positive female patient.