A 35-year-old housewife presented with an 11-year history of a painless lesion on the right cheek, which had enlarged over the last 2 years. She had no history of travel or trauma. Various topical and systemic antimicrobial and antifungal agents, such as fluconazole, ketoconazole, sulbactam/ampicillin, and mupirocin, had been prescribed, with a probable diagnosis of pyoderma. and blastomycosis, without significant benefit. Her medical history was otherwise unremarkable. Dermatologic examination revealed a well-circumscribed, erythematous, infiltrative, 8 X 10 cm plaque covering the right cheek and a 2 X 3.5 cm vegetative, ulcerated lesion on the chin (Fig. 1). There were no sinus tracts or grains.