Photo Rounds

Hyperpigmented growth on nose

A 51-year-old man presented to his family physician (FP) with a growth on his nose that he’d had for 6 months. He admitted to trying to squeeze the growth like a pimple, but it never seemed to go away. The growth appeared to be a pearly hyperpigmented papule that was approximately 3 mm in diameter. Concerned that the growing papule could be a basal cell carcinoma or another skin cancer, the FP performed a shave biopsy under local anesthesia (lidocaine and epinephrine, which can safely be used for surgery of the nose).

What’s your diagnosis?


At follow-up 2 weeks later, pathology revealed a diagnosis of sebaceous hyperplasia (SH). On close examination of the face and nose, the FP noted other nonpigmented SHs and telangiectasias, which confirmed an overall diagnosis of rosacea.

The FP explained to the patient that SH is benign and that there are treatments for rosacea. In this case, the FP prescribed 1% metronidazole gel for the rosacea. At follow-up one month later, the shave biopsy had effectively removed the SH and the site had healed well. The metronidazole gel was also improving the appearance of the patient’s face. The patient indicated that he’d been avoiding the sun and drinking less alcohol, which was helping the rosacea and was, of course, good for his overall health.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Smith M. Sebaceous hyperplasia. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine . 2nd ed. New York, NY: McGraw-Hill; 2013: 931-934.

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