A 34-year-old Hispanic woman presented to her primary care physician with a 4-month history of a nonhealing ulcer on her left hand. She stated that she had initially cut her hand on a broken plate while washing dishes. She was treated with local wound care and systemic antibiotics for several months, without improvement. Radiographs and a bone scan revealed no evidence of osteomyelitis. Skin culture revealed nonpathogenic organisms including Staphylococcus epidermis and diphtheroids. The primary care physician then obtained a punch biopsy specimen, which was interpreted as squamous cell carcinoma. A plastic surgeon excised the lesion and preformed a skin graft. After 6 weeks, the skin graft sloughed and the ulceration returned. A second skin graft was performed and a similar process occurred in the ensuing 5 weeks.
Guccione JL. Palmar Ulceration. Arch Dermatol. 1999;135(7):845-a-850. doi:10-1001/pubs.Arch Dermatol.-ISSN-8503-987x-135-7-dof0799