A 43-year-old African-American man with a 20-year history of discoid lupus erythematosus presented to the Veterans Administration Hospital in New Orleans for evaluation of tumors of the scalp and arm. He was using a topical steroid ointment and sunscreens daily. The medical records indicated that he had a long history of noncompliance with medical therapy including antimalarials and oral corticosteroids. Examination of the scalp showed a cutaneous horn of the left parietal region measuring 3 x 4 cm at the base and 5 cm in height and cicatricial alopecia. The lateral aspect of the right arm showed an exophytic mass measuring 8 x 10 cm arising within an atrophic scarred plaque. The patient also had disseminated atrophic, hyperkeratotic, depigmented plaques in a photodistribution. No palpable adenopathy suggestive of metastatic disease was found. Review of systems was significant only for photosensitivity. The following laboratory studies were negative or within normal limits: ANA (Hep-2 substrate), ssA, ssB, dsDNA, RNP, CBC, biochemical profile, urine analysis, lupus band, RPR, rheumatoid factor, and chest x-ray. Erythrocyte sedimentation rate was elevated at 32. Skin biopsies of the cutaneous horn and exophytic arm lesion showed invasive sec. The patient was referred for excision and full-thickness skin grafts. Following excision, he remained noncompliant with medical therapy and was lost to follow-up. DiseussiON

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Intradermal injection of processed fat results in deposition of fibrous material and collagen due to the response of the recipient site. The material itself contains very little collagen.