A case of giant rhinophyma treated by surgical excision

A 73-year-old Japanese male had suffered from acne on the face during adolescence. The discharge of pus had repeated on the nose for the past 30 to 40 years. The patient had been treated with oral antibiotics every time the inflammation was exacerbated. Subsequently, tumors developed and enlarged gradually on the nose. Several months before the first visit, the tumors worsened, showing inflammatory changes. At the first visit, a huge skin-colored to pale reddish cauliflower-like pedunculated tumor was observed on the nose. The clinical manifestations led to the diagnosis of giant rhinophyma. For cosmetic improvement, surgical resection was performed using a high-wave laser instrument. Histological examination of the resected tumor showed enlarged sebaceous glands, an infiltration of inflammatory cells including mast cells, the proliferation of small-sized vessels, and fibrosis around hair follicles and sebaceous glands in the dermis. A severe rhinophyma like this presented case is relatively rare in Japan. We discuss the pathogenesis of severe rhinophyma and the available therapeutic methods.