Granuloma formation is mediated by tumor necrosis factor-alpha (TNF-α), a pro-inflammatory cytokine secreted by T lymphocytes, monocytes, and macrophages; it maintains granuloma structure by increasing adhesion molecule expression and producing reactive oxygen and nitrogen intermediates [2]. Early lesions may show superficial ulceration, epidermal hyperplasia, and a dense inflammatory infiltrate in the dermis. This evidence concerns the gene TNF and Granuloma.