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September 20, 2010

Tender Papules and Plaques Adjacent to a Scar—Quiz Case

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Copyright 2011 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2011

Arch Dermatol. 2011;147(1):109-114. doi:10.1001/archdermatol.2010.402-a

A 57-year-old white woman presented with a 3-month history of cutaneous papules and plaques adjacent to a scar on the dorsal left forearm; the lesions had appeared 3 months after excision of a large, subcutaneous mass. Her medical history included diabetes mellitus, idiopathic hepatic dysfunction, and hypothyroidism. Medications included metformin hydrochloride, insulin glargine, levothyroxine sodium, and mycophenolate mofetil.

Physical examination demonstrated multiple, slightly tender, pink to brown papules and plaques measuring 3 to 15 mm, adjacent to a well-healed scar on the dorsal left forearm (Figure 1). Diascopy revealed a residual, yellowish-brown hue. On the dorsal right forearm there was a firm, mobile, slightly tender, subcutaneous mass measuring 9 × 4 cm (Figure 2). Several grayish-brown scaly nodules were noted on both shins. A chest computed tomographic scan showed mild mediastinal and hilar lymphadenopathy, and liver function tests revealed a mild transaminitis. Results from a complete blood cell count, comprehensive metabolic panel, thyroid-stimulating hormone, and angiotensin-converting enzyme levels were within reference range. The excisional biopsy specimen from the left forearm was reviewed (Figure 3).

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