A 57-year-old previously healthy woman who works in the fish-processing industry presented with a 1-year history of a slightly pruritic, hyperkeratotic, brownish, erythematous lesion of the left cheek measuring 5 × 5 mm in diameter. Histopathology revealed granuloma formation in the superficial dermal layer by multinucleated giant cells that contained pale-brown septate hyphae. Periodic acid-Schiff stain showed many hyphae and catenate spores within the multinucleated giant cells.
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