A healthy-appearing 5-year-old girl comes to the dermatology clinic for evaluation of a lesion on her face that has been present for at least 3 years. The lesion started as a pimple-like growth on her left superior cheek near the lower eyelid, subsequently grew in size, but has been stable in size for the past 1 to 2 years. The lesion is only occasionally tender when bumped, but the patient and parents report no precipitating trauma to the area. The lesion previously was believed to be a wart and was treated with imiquimod (a topical immune response modifier used to treat superficial basal cell carcinoma, actinic keratosis, and external genital and perianal warts), but no significant change was seen after approximately 2 weeks of use. Later, a primary care physician applied liquid nitrogen cryotherapy to the lesion, resulting in only some superficial sloughing.
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