A healthy 50-year-old woman presented to the dermatology office with a 4-month history of asymptomatic, slow-growing ulcerative skin lesions on her nose, back, and buttocks. She also had recurrent ear pain, sinus infections, nasal congestion, and bleeding gingiva. An ulcerated violaceous nodule was present on the right nasal ala, and there were 3 small ulcers on the neck, back, and buttocks. Oral examination was significant for friable, hyperplastic gingiva with multiple petechiae (Figure).