Figure 2. Histologic features of TTS on punch biopsy. Specimen of right nasal ala (A) at 10X magnification shows hyperkeratosis, marked irregular acanthosis and hypergranulosis without significant keratinocytic atypia. Dermal fibrosis and chronic inflammation are present. Specimen of right upper cutaneous lip (B) at 4X magnification shows ulceration with irregular acanthosis and no significant keratinocytic atypia. Dermal fibrosis and chronic inflammation are present.