Derm Dx: Recurrent, ulcerating, perforating lesion on the nose

At the insistence of her daughter, a 72-year-old woman sought treatment for a deep nasal ulceration that had perforated the skin and cartilage and exposed her nasal septum. The lesion occasionally bled but otherwise caused minimal symptoms.

The patient wore a large bandage whenever she was in public. Years earlier, she had had a nasal growth removed by her general practitioner, ...