Saddle-Nose Deformity in the Setting of Diffuse Cutaneous Lesions in an African American Man

A 66-year-old African American man presented to the otolaryngology clinic with a several-month history of severe nasal congestion. Five years before this otolaryngology evaluation, the patient developed diffuse skin plaques with erythema and was subsequently diagnosed with hypopigmented cutaneous T-cell lymphoma (CTCL, mycosis fungoides type). The patient was treated with a regimen of narrowband UV-B phototherapy and triamcinolone cream, which he has continued for 4 years. Owing to significant worsening of his symptoms 4 months before his evaluation, a biopsy of his cutaneous lesions was performed to rule out progression of CTCL (Figure 1). Physical examination demonstrated large annular plaques with peripheral hyperpigmentation of the body. There were also confluent, indurated pink plaques with slightly raised edges along the forehead, malar eminence, and scalp. The nasal septum demonstrated an inverted V deformity with compromise of the keystone junction. Nasal passages were obstructed with thick mucus and synechiae formation, nearly obstructing the entire nasal passage bilaterally.