History of the present illness
This is a 44-year-old African-American male who first presented to his physician for a skin problem and scaling of the scalp.  The skin problem was diagnosed as psoriasiform dermatitis and was treated with desonide 0.05% ointment twice a day.  For the scalp scaling, he was using ketoconazole 2% and selenium sulfide shampoos on a regular basis.  On one of his clinical presentations to his dermatologist, he complained about three enlarging nodules in his mouth: one on the anterior hard palate, one on the soft palate and a third enlarging purplish-red swelling on the maxillary buccal gingiva between teeth #s 5 and 6 (Fig 1).  He was referred to Dr. Beirne for evaluation of the swellings.  He stated that these lesions were not painful but that they were growing fast and were bothersome.  The soft palate lesion was obstructive to the oropharynx.