Keratinocytic Carcinoma Arising in Association With Granuloma Faciale: A Case Report

Granuloma faciale (GF) is a rare, benign, chronic dermatosis that typically presents as reddish-brown to violaceous plaques on the face. Here, we report the first documented case of GF arising in association with both squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). A 79-year-old man with a history of several non-melanoma skin cancers presented with new lesions on the right cheek and ear. Biopsies confirmed GF on the cheek and SCC on the ear, with adjacent inflammatory infiltrates also consistent with GF. Additionally, subsequent Mohs micrographic surgery revealed a distinct, coexisting BCC within the same lesion. To our knowledge, only two cases of GF co-occurring with BCC have been reported, and none with concurrent SCC's. This case highlights the diagnostic complexity of GF in patients with a history of skin cancer and underscores the importance of histopathologic confirmation when evaluating persistent or overlapping lesions. The unique triad of GF, SCC, and BCC reflects potential inflammatory or immune-mediated mechanisms linking chronic dermatoses with carcinogenesis and warrants further investigation.