Six years ago, a lesion appeared on this now 39-year-old woman’s forehead. It grew steadily to its current size, impinging on her brow line. Although it has been asymptomatic, the patient is concerned about malignancy, since she has a significant personal and family history of skin cancer. She has had several lesions removed from her face and back over the years.
There is a 2.2-cm, roughly round, white, cicatricial, concave lesion on the patient’s lower right forehead, extending into the brow line. Around the periphery are several 2- to 5-mm eroded papules. There are no palpable nodes on the head or neck.
Several scars are seen elsewhere on the patient’s face and back, consistent with her history. Her type II/VI skin is quite fair and sun-damaged.
A 6-mm deep punch biopsy of the lesion is obtained.
What is the diagnosis?