A 72-Year-Old Man Is Seen for an Evaluation of a Scaly

A 72-year-old man is seen for an evaluation of a scaly lesion behind his right ear. A biopsy confirms the diagnosis of squamous cell carcinoma, and the lesion is excised with clear margins. Secondary intention allows the wound to heal. The patient returns to the office three weeks later with a 2.5-cm raised, soft, granular lesion at the excision site. The image below depicts a biopsy of a representative lesion: Which of the following is most likely responsible for this patient's postoperative changes?

A) Deposition of immunoglobulin-derived fibrils
B) Excess production of type I collagen
C) Proliferation of dysplastic keratinocytes
D) Recruitment and degranulation of neutrophils
E) VEGF-induced tissue proliferation

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