Hard nontender masses over the left mandible and scapula.

(Chest 1991; 100:1444-46) A 71-year-old white male farmer presented with a five-week history of a mass on his left mandible. He had a 70 pack-year smoking history. He reported a 9.1 kg (20 pound) weight loss and occasional production of blood streaked sputum. There was a nontender, freely mobile and erythematous 5 cm nodule on his left mandible (Fig 1). He also had a fixed, firm, nontender 3 cm mass overlying the tip of his left scapula. There was no associated lymphadenopathy or other skin lesions. What is the diagnosis? a) Primary head and neck carcinoma b) Blastomycosis c) Ameloblastoma d) Actinomycosis e) Tumor metastatic to skin