A 2-YEAR-OLD white boy presented with a painful mass on the right cheek. The patient was otherwise healthy and had all immunizations. There was no history of fever, change in behavior or appetite, or weight loss. The mass was overlying the malar prominence and had been present for 4 months; it had gradually increased in size, was painless, and was not ulcerated.
Examination revealed a firm 1×1.5-cm nodule in the subcutaneous tissue. The nodule was firm, well circumscribed, adherent to skin, and slightly tender to palpation. The overlying skin was smooth, showing a faint bluish discoloration. No cervical lymphadenopathy was detected. The remainder of the examination was unremarkable and failed to reveal similar lesions. Results of routine laboratory tests, including a complete blood cell count, and chest radiographs were within the normal range. Results of a purified protein derivative test were negative, with a positive control.
An excisional biopsy