CASE PRESENTATION
—Sidney Yoon, MDA 53-YEAR-OLD white man presented to The Johns Hopkins Hospital, Baltimore, Md, with erythematous lesions on his nose, ear, and palate. He was well until March 1987, when he developed a painful palatal lesion that made it so difficult to swallow that he lost 9 kg. Three months later a lesion developed on his nose that caused intermittent epistaxis, and after another 3 months a lesion developed behind his right ear. All three lesions persisted and enlarged slowly. Biopsy samples were believed to be nondiagnostic but suggestive of epithelioma. Bacterial cultures of the biopsy samples were negative. He denied fever, chills, chest pain, productive cough, headaches, and changes in his bowel habits. He recently noted nocturia and dribbling of urine.His medical and family histories were noncontributory. He worked for the Maryland State Highway Administration for 20 years as a grass trimmer, weeder, and