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A Hispanic man age 23 years presented with a nine-month history of a nonhealing ulcer of his cheek. The erosion began as a small, painless erosion and had gradually enlarged. The patient was living in southern Mexico when the condition developed and recently moved to the United States. He has had multiple insect bites on his face but no more significant trauma. The ulcer was mildly pruritic but never painful. No drainage from the ulcer was reported and the patient has had no fevers, chills, or other systemic symptoms. The rest of the physical exam was unremarkable with no other skin lesions and no lymphadenopathy.

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