Prepared by Mark Miller, MD, Fellow, Department of Medicine, Division of Infectious Diseases, Los Angeles County/University of Southern California Medical Center, Los Angeles, Calif

A 58-year-old Mexican man presents with a fungating mass on the right malar aspect of his face (Figure 1), which has been growing over a 3-month period and is not painful. The lesion is raised and has a rubbery consistency. He had been an agricultural worker in northern California. Although he has not traveled outside California in the past 10 years, he has traveled in the San Joaquin Valley seeking employment. He has no pets and recounts no industrial exposure.

What’s Your Diagnosis?

Psoriasis

Molluscum contagiosum

Febrile neutrophilic dermatosis (Sweet’s syndrome)

Coccidioidomycosis