A 59-year-old woman who was otherwise healthy presented for evaluation of an annular plaque on the left forehead. The plaque had an erythematous scaly raised border, and the central portion was hypopigmented and subtly atrophic (Figures 1 and 3). The plaque was solitary, as a full body examination did not reveal additional cutaneous lesions. It was asymptomatic and longstanding but had been slowly expanding. A biopsy of the plaque had been previously performed in 2004, at which time the patient was under the care of a different clinical team. At the time, scant clinical information was included with the specimen. The 2004 biopsy showed tightly packed nodular collections of histiocytes and was interpreted as probably representing sarcoidosis. Subsequent systemic evaluation for sarcoidosis, including a chest x-ray and an angiotensin converting enzyme (ACE) level, was negative.The patient recently presented to our institution, where our clinicians were unable to reconcile the histopathology with the clinical presentation. Therefore, an additional biopsy was performed. The biopsy showed dense small and large compact sarcoidal aggregations of histiocytes distributed in a vaguely band-like configuration in the upper dermis (Figures 2 and 4). The aggregations were accompanied by small lymphocytes (Figures 4 and 5). A diagnosis of sarcoidal granulomatous dermatitis was rendered, and a differential diagnosis that included sarcoidosis, infection, granulomatous rosacea, and a cutaneous manifestation of Crohn's disease was offered. Special stains (Fite, PAS-D, and Brown-Brenn) were performed and failed to reveal organisms (mycobacteria, fungi and bacteria, Fig. 1. Frontal view displaying an annular plaque with an erythematous raised border and central subtle atrophy with hypopigmentation.