A 48-year-old white man with a 7-year history of human immunodeficiency virus presented with a large ulcerated tumor on his back. His medical history included surgical removal of a colon cancer 20 years earlier. He had no family history of sebaceous carcinoma or cancer of the gastrointestinal tract. His last CD4 cell count was 4 µL (reference range, 400-2120/µL), and he had felt weak for the past few months.
On physical examination, an ulcerated tumor measuring 15 × 7 cm in greatest dimension was observed on the patient's upper back area (Figure 1). Necrotic tissue was seen on the surface of the tumor. Further skin examination revealed no similar lesions. A 4-mm punch biopsy specimen was obtained from the middle of the tumor (Figure 2).
Kuwahara RT, Rudolph TM, Skinner, Jr RB, Rasberry RD. A Large Ulcerated Tumor on the Back. Arch Dermatol. 2001;137(10):1367-1372. doi: