Recurring Congenital Lesion of the Cheek

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Abstract
A 3-cm purple area was present on the left cheek of a newborn white female, and a biopsy showed atypical cells in fibroadipose tissue. The lesion increased in size and the infant was referred to the M. D. Anderson Hospital. By 6 weeks, the lesion formed an irregular 6-cm paranasal mass, compressing the nostril and depressing the corner of the mouth. It was soft and mobile with a nodular, erythematous, excoriated surface. Three small satellite masses were also present. Another biopsy was obtained, establishing the presence of a malignant neoplasm. Vincristine, adriamycin, and cyclophosphamide produced a rapid decrease in size of the lesion, and by 6 months it was considerably smaller and firmer. Total surgical excision was then performed. The well-circumscribed 3-cm nodule had a glistening, tan-gray cut surface. The wound was closed with a skin graft, and By 11 months, the lesion had recurred as a firm, round mobile nodule in the premaxillary area, lateral to the previous surgical site. The reexcision specimen revealed a firm, pale tan, 2-cm mass with a lobulated cut surface. In view of the previous reqoonse, chemotherapy with vincristine, adriam ycin, and cyclophosphamide was reinstated, with modification of the dose and schedule. Clinical evidence of adriam ycin cardiom yopath y developed, the chil's condition deteriorated, and she died at the age of 18 months. Autopsy was not performed.