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March 2011March 21, 2011

Violaceous Plaques in a Collarlike Distribution—Quiz Case

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Arch Dermatol. 2011;147(3):345-350. doi:10.1001/archdermatol.2011.38-a

A 62-year-old African American man with no significant medical history presented with a 3-week history of a warm, tender cutaneous eruption beginning on his chest and rapidly spreading around the base of his neck and upper trunk. He had a 60–pack-year tobacco-smoking history and a remote history of alcohol and heroin abuse. Findings from a review of systems was significant for a 40-lb (18-kg) unintentional weight loss over the preceding 4 months, memory loss, and nausea with vomiting but were negative for cough, hemoptysis, or dyspnea. Physical examination revealed a cachectic but otherwise comfortable man with confluent deep red to violaceous plaques over the base of the neck, chest, and upper back as well as cervical lymphadenopathy (Figure 1). A biopsy of the right upper chest was performed (Figure 2 and Figure 3).

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